Lifelong latent HBV monitoring cost effective in China

Implementing lifelong monitoring for carriers of inactive chronic hepatitis B virus has the potential to reduce the financial burden of the disease in China, researchers have found.

Qing Xie, of the Children’s Hospital of Fudan University in Shanghai, and colleagues used a computer simulation model to project health outcomes among a cohort of patients with chronic HBV based upon age-specific prevalence of HBsAg, HBeAg and cirrhosis.

Inactive chronic HBV carriers make up the largest group of infected patients, so Xie and colleagues examined the population health impact and cost-effectiveness of a strategy consisting lifelong monitoring for inactive chronic HBV and treatment.

They simulated disease progression through a series of health states and then compared current practice with the monitor and treat strategy, based on an estimated 1.5 million cases of chronic HBV in Shanghai during the study period.

The researchers measured lifetime costs and quality adjusted life years (QALYs), incremental cost-effectiveness ratios (ICERs) and clinical outcomes, such as development of hepatocellular carcinoma (HCC).

If adherence levels were roughly 35% consistent with current patterns, the estimated cost-effective ratio for lifelong HBV monitoring would be $2,996 per QALYs gained when compared with current practice, the researchers found. 

The expected cost of the monitor and treat strategy was $20,730 per patient and the QALY was 15.45. This translates into incremental costs and health benefits of $275 and 0.10 QALYs vs. current practice, and an incremental cost-effectiveness ratio of $2,996 per QALY gained.

However, the computer simulation model showed the model did not significantly decrease mortality from chronic hepatitis B or hepatocellular carcinoma.

Current monitor and treat strategies are estimated to reduce hepatocellular carcinoma and chronic HBV-associated mortality by only about 1%. But improving HBV monitoring and treatment strategies has the potential to reduce hepatocellular carcinoma 70% and chronic HBV-associated mortality by 83%, the researchers projected.

“Lifelong monitoring of inactive chronic [HBV] 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 chronic hepatitis B-infected cases in the population, and increasing rates of treatment, monitoring and treatment adherence.”