This article is more than 5 years old. Information may no longer be current.
Monitoring inactive chronic HBV carriers appears cost-effective
Click Here to Manage Email Alerts
Recent study data have found that lifelong monitoring of individuals carrying dormant chronic hepatitis B in Shanghai appears to be cost-effective, but meaningful effects on hepatocellular carcinoma, cirrhosis and chronic hepatitis B mortality would require increased testing, follow-up and treatment rates of active patients.
The study sought to determine the health benefits and cost-effectiveness of a monitor-and-treat (M&T) strategy for current inactive chronic HBV patients, a practice not currently implemented in China.
The researchers estimated health outcomes using a computer simulation model on a population cohort of Shanghai residents with known inactive chronic HBV. Determination of inactive chronic HBV was based on age-specific presence of hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg), as well as cirrhosis. A Markov model was used to replicate disease progression through various stages and to compare the current standards with an M&T strategy. The model addressed the study’s clinical endpoints, defined as cirrhosis, hepatocellular carcinoma (HCC), and chronic HBV-related mortality. The model also yielded abridged measures of lifetime costs and quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios.
The researchers identified approximately 1.5 million adults infected with chronic HBV in Shanghai and projected that an M&T approach would cost $20,730, yielding 15.45 QALYs per patient. This would equate to incremental costs and health benefits of $275 and 0.1 QALYs vs. the present standard, and an incremental cost-effectiveness ratio of $2,996 per QALY gained.
The researchers said the costs savings achieved through an M&T strategy would be augmented if the cost of the drug entecavir (Baraclude, Bristol-Myers Squibb) could be reduced by 50%.
In terms of health gains, the researchers found that the implementation of lifelong monitoring would yield only a 1% reduction in cirrhosis, HCC and chronic HBV-associated mortality vs. current practice. Sensitivity analysis projected that if factors such as compliance to monitoring and treatment were to be significantly improved, an M&T strategy could decrease HCC by 70% and chronic HBV-related mortality by 83%.
“Monitoring of inactive cases can achieve substantial health gains, but these gains will depend critically on ability to identify more HBsAg-positive cases, and to improve rates of treatment and adherence to monitoring,” the researchers wrote.
Disclosure: The researchers report no relevant financial disclosures.
Click Here to Manage Email Alerts