Population health impact and cost-effectiveness of monitoring inactive chronic hepatitis B and treating eligible patients in Shanghai, China

Abstract

Inactive chronic hepatitis B (CHB) carriers make up the largest group of hepatitis B virus-infected patients, and China bears the largest total CHB burden of any country. We therefore assessed the population health impact and cost-effectiveness of a strategy of lifelong monitoring for inactive CHB and treatment of eligible patients in Shanghai, China. We used a computer simulation model to project health outcomes among a population cohort of CHB based on age-specific prevalence of hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), and cirrhosis. Using a Markov model we simulated patients' progression through a discrete series of health states, and compared current practice to a monitor and treat (M&T) strategy. We measured lifetime costs and quality-adjusted life years (QALYs) (both discounted at 3% per year), incremental costeffectiveness ratios (ICERs), and clinical outcomes such as development of hepatocellular carcinoma (HCC). We estimated that there are 1.5 million CHB-infected persons in Shanghai. The M&T strategy costs US$20,730 per patient and yields a discounted QALY of 15.45, which represents incremental costs and health benefits of US$275 and 0.10 QALYs compared to current practice, and an ICER of US$2,996 per QALY gained. In the base case, we estimated that the M&T strategy will reduce HCC and CHB-related mortality by only around 1%. If variables such as adherence to monitoring and treatment could be substantially improved the M&T strategy could reduce HCC by 70% and CHB-related mortality by 83%. Conclusion: Lifelong monitoring of inactive CHB carriers is cost-effective in Shanghai according to typical benchmarks for value for money, but achieving substantial population-level health gains depends on identifying more CHB-infected cases in the population, and increasing rates of treatment, monitoring, and treatment adherence. (HEPATOLOGY 2014;60:46-55)

Effects of nucleoside analogue prescription for hepatitis B on the incidence of liver cancer in Hong Kong: a territory-wide ecological study

“…Serum HBsAg seroprevalence rates in East Asia for ≥65 years are similar to that of younger age groups, yet a previous study from our locality showed patients of ≥65 years comprised only 3.4% of total CHB specialist clinic cohort, implying a considerable proportion of elderly CHB patients were probably not referred to appropriate specialist care. Drug non‐adherence, common in the elderly population, could be also an important factor.…”

Estimating cost-effectiveness associated with all-oral regimen for chronic hepatitis C in China

“…It was not appropriate for advanced complications because of more than once for hospitalization and excess costs from outpatient. So annual costs of decompensated cirrhosis and hepatocellular carcinoma were estimated from studies on chronic hepatitis B (CHB) in China [31, 32], with the assumption made specifically for this study: annual costs for advanced complications of CHB patients are identical to CHC patients. Furthermore, the estimated annual costs for patients receiving liver transplant were derived from Chinese patients [33, 34].…”

Postpartum care for mothers diagnosed with hepatitis B during pregnancy

“…These patients require lifelong surveillance by a physician experienced in the management of chronic liver disease as early antiviral therapy can prevent the progression of liver disease and HCC, 1, 4, 7 and has been shown to be cost effective in decision analysis models. 27 In one study, the risk of developing cirrhosis amongst chronic inactive carriers was 15% over 25 years. 28 It is important to also note that more than half (54%) of the mothers in our cohort who were tested were HBeAb positive and therefore are at risk for developing active hepatitis in the form of HBeAb positive/HBeAg negative chronic hepatitis.…”