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

Authors

  • Mehlika Toy,

    Corresponding author
    1. Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA
    2. Department of Public Health, Erasmus Medical Centre, Rotterdam, the Netherlands
    • Address reprint requests to: Mehlika Toy, Ph.D., D.Sc., Research Associate, Department of Global Health and Population, 665 Huntington Ave., Building 1, Room 1210A, Boston, MA 02115. E-mail: mtoy@hsph.harvard.edu; or Prof. Qing Xie, Shanghai Ruijin Hospital, Jiaotong University School of Medicine, 197 Ruijin Er Road, 36 Building, 4th floor, Shanghai, 200025, China. E-mail: xieqingrjh@163.com; fax: +86-21-64454930.

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  • Joshua A. Salomon,

    1. Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA
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  • Hao Jiang,

    1. Department of Infectious Diseases, Shanghai Jiao Tong University, Rui Jin Hospital, Shanghai, China
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  • Honglian Gui,

    1. Department of Infectious Diseases, Shanghai Jiao Tong University, Rui Jin Hospital, Shanghai, China
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  • Hui Wang,

    1. Department of Infectious Diseases, Shanghai Jiao Tong University, Rui Jin Hospital, Shanghai, China
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  • Jiangshe Wang,

    1. Department of Pediatrics, Children's Hospital of Fudan University, Shanghai, China
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  • Jan Hendrik Richardus,

    1. Department of Public Health, Erasmus Medical Centre, Rotterdam, the Netherlands
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  • Qing Xie

    Corresponding author
    1. Department of Infectious Diseases, Shanghai Jiao Tong University, Rui Jin Hospital, Shanghai, China
    • Address reprint requests to: Mehlika Toy, Ph.D., D.Sc., Research Associate, Department of Global Health and Population, 665 Huntington Ave., Building 1, Room 1210A, Boston, MA 02115. E-mail: mtoy@hsph.harvard.edu; or Prof. Qing Xie, Shanghai Ruijin Hospital, Jiaotong University School of Medicine, 197 Ruijin Er Road, 36 Building, 4th floor, Shanghai, 200025, China. E-mail: xieqingrjh@163.com; fax: +86-21-64454930.

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  • Potential conflict of interest: Nothing to report.

  • Supported by the Takemi Program in International Health at Harvard School of Public Health.

  • See Editorial on Page 19

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. (Hepatology 2014;60:46–55)

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