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Population health impact and cost-effectiveness of monitoring inactive chronic hepatitis B and treating eligible patients in Shanghai, China.
Hepatology. 2014 Jul; 60(1):46-55.Hep

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 cost-effectiveness 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.

Authors+Show Affiliations

Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA; Department of Public Health, Erasmus Medical Centre, Rotterdam, the Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24990105

Citation

Toy, Mehlika, et al. "Population Health Impact and Cost-effectiveness of Monitoring Inactive Chronic Hepatitis B and Treating Eligible Patients in Shanghai, China." Hepatology (Baltimore, Md.), vol. 60, no. 1, 2014, pp. 46-55.
Toy M, Salomon JA, Jiang H, et al. Population health impact and cost-effectiveness of monitoring inactive chronic hepatitis B and treating eligible patients in Shanghai, China. Hepatology. 2014;60(1):46-55.
Toy, M., Salomon, J. A., Jiang, H., Gui, H., Wang, H., Wang, J., Richardus, J. H., & Xie, Q. (2014). Population health impact and cost-effectiveness of monitoring inactive chronic hepatitis B and treating eligible patients in Shanghai, China. Hepatology (Baltimore, Md.), 60(1), 46-55. https://doi.org/10.1002/hep.26934
Toy M, et al. Population Health Impact and Cost-effectiveness of Monitoring Inactive Chronic Hepatitis B and Treating Eligible Patients in Shanghai, China. Hepatology. 2014;60(1):46-55. PubMed PMID: 24990105.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Population health impact and cost-effectiveness of monitoring inactive chronic hepatitis B and treating eligible patients in Shanghai, China. AU - Toy,Mehlika, AU - Salomon,Joshua A, AU - Jiang,Hao, AU - Gui,Honglian, AU - Wang,Hui, AU - Wang,Jiangshe, AU - Richardus,Jan Hendrik, AU - Xie,Qing, Y1 - 2014/05/27/ PY - 2013/06/17/received PY - 2013/11/13/accepted PY - 2014/7/4/entrez PY - 2014/7/6/pubmed PY - 2014/9/10/medline SP - 46 EP - 55 JF - Hepatology (Baltimore, Md.) JO - Hepatology VL - 60 IS - 1 N2 - UNLABELLED: 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 cost-effectiveness 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. SN - 1527-3350 UR - https://www.unboundmedicine.com/medline/citation/24990105/Population_health_impact_and_cost_effectiveness_of_monitoring_inactive_chronic_hepatitis_B_and_treating_eligible_patients_in_Shanghai_China_ L2 - https://doi.org/10.1002/hep.26934 DB - PRIME DP - Unbound Medicine ER -