title: Disease burden of chronic hepatitis B among immigrants in Canada.
abstract: BACKGROUND
  The prevalence of chronic hepatitis B (CHB) infection among immigrants to North America ranges from 2% to 15%, 40% of whom develop advanced liver disease. Screening for hepatitis B surface antigen is not recommended for immigrants.
  
  
  OBJECTIVE
  To estimate the disease burden of CHB among immigrants in Canada using Markov cohort models comparing a cohort of immigrants with CHB versus a control cohort of immigrants without CHB.
  
  
  METHODS
  Markov cohort models were used to estimate life years, quality-adjusted life years and lifetime direct medical costs (adjusted to 2008 Canadian dollars) for a cohort of immigrants with CHB living in Canada in 2006, and an age-matched control cohort of immigrants without CHB living in Canada in 2006. Parameter values were derived from the published literature.
  
  
  RESULTS
  At the baseline estimate, the model suggested that the cohort of immigrants with CHB lost an average of 4.6 life years (corresponding to 1.5 quality-adjusted life years), had an increased average of $24,249 for lifetime direct medical costs, and had a higher lifetime risk for decompensated cirrhosis (12%), hepatocellular carcinoma (16%) and need for liver transplant (5%) when compared with the control cohort.
  
  
  CONCLUSIONS
  Results of the present study showed that the socio-economic burden of CHB among immigrants living in Canada is substantial. Governments and health systems need to develop policies that promote early recognition of CHB and raise public awareness regarding hepatitis B to extend the lives of infected immigrants.
authors.forename: William W L
authors.initials: WW
authors.lastname: Wong
authors.forename: Gloria
authors.initials: G
authors.lastname: Woo
authors.forename: E Jenny
authors.initials: EJ
authors.lastname: Heathcote
authors.forename: Murray
authors.initials: M
authors.lastname: Krahn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use; D002170:Canada; D006528:Carcinoma, Hepatocellular / Q000191:economics* / Q000209:etiology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D017281:Cost of Illness; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs; D019694:Hepatitis B, Chronic / Q000150:complications / Q000188:drug therapy / Q000191:economics*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008103:Liver Cirrhosis / Q000191:economics* / Q000209:etiology / Q000601:surgery; D008113:Liver Neoplasms / Q000191:economics* / Q000209:etiology / Q000601:surgery; D016031:Liver Transplantation / Q000191:economics*; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D055815:Young Adult
chemical_list: D000998:Antiviral Agents