title: 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 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%.
  
  
  CONCLUSIONS
  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.affiliation: Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA; Department of Public Health, Erasmus Medical Centre, Rotterdam, the Netherlands.
authors.forename: Mehlika
authors.initials: M
authors.lastname: Toy
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Salomon
authors.forename: Hao
authors.initials: H
authors.lastname: Jiang
authors.forename: Honglian
authors.initials: H
authors.lastname: Gui
authors.forename: Hui
authors.initials: H
authors.lastname: Wang
authors.forename: Jiangshe
authors.initials: J
authors.lastname: Wang
authors.forename: Jan Hendrik
authors.initials: JH
authors.lastname: Richardus
authors.forename: Qing
authors.initials: Q
authors.lastname: Xie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000191:economics / Q000401:mortality / Q000821:virology; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D019694:Hepatitis B, Chronic / Q000188:drug therapy / Q000191:economics / Q000401:mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008113:Liver Neoplasms / Q000191:economics / Q000401:mortality / Q000821:virology; D008390:Markov Chains; D008875:Middle Aged; D015166:Monitoring, Immunologic / Q000191:economics*; D015995:Prevalence; D019057:Quality-Adjusted Life Years; D038301:Virus Inactivation; D055815:Young Adult
chemical_list: D000998:Antiviral Agents