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Nan Y, Garay OU, Lu X, Zhang Y, Xie L, Niu Z, Chen W. Early-stage hepatocellular carcinoma screening in patients with chronic hepatitis B in China: a cost-effectiveness analysis. J Comp Eff Res 2024; 13:e230146. [PMID: 38415341 PMCID: PMC11044951 DOI: 10.57264/cer-2023-0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 02/12/2024] [Indexed: 02/29/2024] Open
Abstract
Aim: To evaluate the cost-effectiveness of seven screening strategies for chronic hepatitis B (CHB) patients in China. Methods: A discrete event simulation model combining a decision tree and Markov structure was developed to simulate a CHB cohort aged ≥40 years on a lifetime horizon and evaluate the costs and health outcomes (quality-adjusted life years [QALYs] gained) of ultrasonography (US), alpha-fetoprotein (AFP), protein induced by vitamin K absence-II (PIVKA-II), AFP+US, AFP+PIVKA-II, GAAD (a diagnostic algorithm based on gender and age combined with results of AFP and PIVKA-II) and GAAD+US. Epidemiologic, clinical performance, utility and cost data were obtained from the literature, expert interviews and real-world data. Uncertainties on key parameters were explored through deterministic and probabilistic sensitivity analyses (DSA and PSA). Results: Compared with other strategies, GAAD+US detected the most HCC patients at early stage, and GAAD was the screening strategy with the lowest average cost per HCC case diagnosed. Using 3× China's 2022 GDP per capita ($38,233.34) as the threshold, the three strategies of US, GAAD and GAAD+US formed a cost-effectiveness frontier. Screening with US, GAAD, or GAAD+US was associated with costs of $6110.46, $7622.05 and $8636.32, and QALYs of 13.18, 13.48 and 13.52, respectively. The ICER of GAAD over US was $4993.39/QALY and the ICER of GAAD+US over GAAD was $26,691.45/QALY, which was less than 3× GDP per capita. Both DSA and PSA proved the stability of the results. Conclusion: GAAD+US was the most cost-effective strategy for early HCC diagnosis among CHB patients which could be considered as the liver cancer screening scheme for the high-risk population in China.
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Affiliation(s)
- Yuemin Nan
- Department of Traditional & Western Medical Hepatology, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | | | - Xianzhong Lu
- Roche Diagnostics (Shanghai) Co., Ltd, Shanghai, 200335, China
| | - Yue Zhang
- Roche Diagnostics (Shanghai) Co., Ltd, Shanghai, 200335, China
| | - Li Xie
- Yidu Cloud (Beijing) Technology Co., Ltd, Beijing, 100083, China
| | - Zhongyi Niu
- Yidu Cloud (Beijing) Technology Co., Ltd, Beijing, 100083, China
| | - Wen Chen
- School of Public Health, Fudan University, Shanghai, 200032, China
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Lai CH, Shi HY, Tsai CE, Yang YC, Chiu SUF. Cost-Utility Analysis of Tenofovir Alafenamide and Entecavir in Chronic Hepatitis B Patients: A Markov Decision Model. Cancers (Basel) 2024; 16:813. [PMID: 38398204 PMCID: PMC10887268 DOI: 10.3390/cancers16040813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/29/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
From the perspective of health economics, the evaluation of drug-related cost effectiveness and clinical utility is crucial. We conducted a cost-utility analysis of two first-line drugs, tenofovir alafenamide (TAF) and entecavir (ETV), in the treatment of chronic hepatitis B (CHB) patients. We performed inverse probability of treatment weighting (IPTW) to match the independent variables between the two treatment groups. The incremental cost effectiveness ratio (ICER) of the two treatment groups was simulated using a decision tree with the Markov annual-cycle model. A total of 54 patients treated with TAF and 98 with ETV from January 2016 to December 2020 were enrolled. The total medical cost in the TAF group was NT$76,098 less than that in the ETV group, and TAF demonstrated more effectiveness than ETV by 3.19 quality-adjusted life years (QALYs). When the time horizon was set at 30 years, the ICER of the TAF group compared with the ETV group was -NT$23,878 per QALY, suggesting more cost savings for TAF. Additionally, with the application of TAF, over NT$366 million (approximately US$12 million) can be saved annually. TAF demonstrates cheaper medical costs and more favorable clinical QALYs than ETV. To balance health insurance benefits and cost effectiveness, TAF is the optimal treatment for CHB.
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Affiliation(s)
- Chun-Huang Lai
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Municipal United Hospital, Kaohsiung 80457, Taiwan; (C.-H.L.); (C.-E.T.)
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Hon-Yi Shi
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Business Management, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 40433, Taiwan
| | - Cheng-En Tsai
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Municipal United Hospital, Kaohsiung 80457, Taiwan; (C.-H.L.); (C.-E.T.)
| | - Yuan-Chieh Yang
- Department of Laboratory Medicine, Kaohsiung Municipal United Hospital, Kaohsiung 80457, Taiwan;
| | - Si-Un Frank Chiu
- Department of Computer Science, Brown University, Providence, RI 02912, USA;
- Department of Economics, Brown University, Providence, RI 02912, USA
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Wu WJ, Lin CL, Liu CJ, Huang YW, Hu JT, Yu MW. Lifetime risk of liver-related outcomes and determinants in male inactive carriers of chronic hepatitis B. J Med Virol 2023; 95:e29138. [PMID: 37796044 DOI: 10.1002/jmv.29138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/11/2023] [Accepted: 09/19/2023] [Indexed: 10/06/2023]
Abstract
The full spectrum of risks for the life course of inactive hepatitis B virus (HBV) carriers remains unclear. In this study, 995 untreated HBV carriers (median age: 42.8 years; median follow-up: 30.2 years) were included. Their data were sourced from a population-based cohort study of male civil servants recruited in 1989-1992. Outcomes were identified by active follow-up examinations and linkage with national health insurance research database. At baseline, 483 subjects were inactive carriers, 385 with indeterminate phase, and 127 with other phases. The joint lifetime risk for incident cirrhosis, decompensation, hepatocellular carcinoma, and liver-related deaths was lower for inactive carriers compared to subjects in other phases (p < 0.0001). There was a trend of increase in incidence among inactive carriers; the 5-, 10-, and 20-year cumulative incidences were 1.86%, 6.03%, and 10.07%, respectively. Of the inactive carriers, 37.7% cleared HBsAg and 36.6% had biochemical relapse during the study. Biochemical relapse, obesity, and advanced age were predictors for disease progression in inactive carriers. Virological relapse was the predominant cause of biochemical relapse. Higher HBV-DNA levels (≥1000 copies/mL or 200 IU/mL) and HBV genotype B (vs. C) were associated with higher virological relapse rate. After 30 years, we found that one-time measure of inactive carrier state continued to have the lowest risk compared with other infection phases. Despite a more favorable prognosis, inactive carriers had a non-negligible risk. Our findings of lifetime risk may provide important clues for the management of such patients and consideration of therapeutic strategies aiming to achieve functional cure.
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Affiliation(s)
- Wan-Jung Wu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chih-Lin Lin
- Department of Gastroenterology, Ren-Ai Branch, Taipei City Hospital, Taipei, Taiwan
| | - Chun-Jen Liu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital and Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Wen Huang
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jui-Ting Hu
- Liver Center, Cathay General Hospital Medical Center, School of Medicine, Fu-Jen Catholic University College of Medicine, Taipei, Taiwan
| | - Ming-Whei Yu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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Li R, Shen M, Ong JJ, Cui F, Hu W, Chan P, Zou Z, Su S, Liu H, Zhang L, Seto WK, Wong WC. Blueprint to hepatitis B elimination in China: A modelling analysis of clinical strategies. JHEP Rep 2023; 5:100833. [PMID: 37675271 PMCID: PMC10477682 DOI: 10.1016/j.jhepr.2023.100833] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/26/2023] [Accepted: 06/15/2023] [Indexed: 09/08/2023] Open
Abstract
Background & Aims Globally, one-third of individuals infected with HBV live in China. Eliminating HBV in China would therefore be paramount in achieving the World Health Organization's (WHO's) targets of viral hepatitis elimination as a worldwide public health threat. Methods We constructed a dynamic HBV transmission model in China, structured by age and sex. We calibrated the model by HBsAg prevalence, acute HBV incidence, and nationally reported HBV-related cancer mortality. We investigated seven intervention scenarios (A-G) based on assumptions in diagnostic, linkage-to-care, and treatment coverages in achieving the WHO's HBV elimination goals. Results With the status quo, HBsAg prevalence among children 1-4 years would reduce to 0.09% (95% CI 0.09-0.10%) by 2025; acute HBV incidence would drop to <2/100,000 person-years by 2024, achieving the elimination target of 90% incidence reduction. Nonetheless, China would not achieve a 65% reduction target in HBV-related mortality until 2059 with 9.98 (95% CI 9.27-10.70) million HBV-related deaths occurred by 2100. If China achieves 90% diagnostic and 80% treatment coverages (scenario E), HBV elimination would be achieved 8 years earlier, potentially saving 1.98 (95% CI 1.83-2.12) million lives. With more effective therapies for HBV control in preventing cirrhosis and hepatocellular carcinoma, elimination targets could be achieved in 2048 (scenario F) and 2038 (scenario G), additionally saving 3.59 (95% CI 3.37-3.82) and 5.19 (95% CI 4.83-5.55) million lives, respectively. Conclusions Eliminating HBV will require interventional strategies to improve diagnostic, linkage-to-care, and treatment coverages. Developing novel therapies will be crucial in further reducing HBV-related mortality and removing HBV as a public health threat. Impact and Implications This study explores the key developments and optimal intervention strategies needed to achieve WHO hepatitis B elimination targets by 2030 in China. It highlights that China can realise the HBV elimination targets in the incidence by 2025, and by upscaling diagnostic, linkage-to-care, and treatment coverages, up to 2 million lives could potentially be saved from HBV-related deaths.
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Affiliation(s)
- Rui Li
- China–Australia Joint Research Centre for Infectious Diseases, School of Public Health, Xi’an Jiaotong University Health Science Centre, Xi’an, China
- Central Clinical School, Faculty of Medicine, Monash University, Melbourne, VIC, Australia
- Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Mingwang Shen
- China–Australia Joint Research Centre for Infectious Diseases, School of Public Health, Xi’an Jiaotong University Health Science Centre, Xi’an, China
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, China
| | - Jason J. Ong
- China–Australia Joint Research Centre for Infectious Diseases, School of Public Health, Xi’an Jiaotong University Health Science Centre, Xi’an, China
- Central Clinical School, Faculty of Medicine, Monash University, Melbourne, VIC, Australia
- Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Fuqiang Cui
- School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, China
| | - Wenyi Hu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
- Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, VIC, Australia
| | - Polin Chan
- Communicable Diseases Team, WHO India Country Office, New Delhi, India
| | - Zhuoru Zou
- China–Australia Joint Research Centre for Infectious Diseases, School of Public Health, Xi’an Jiaotong University Health Science Centre, Xi’an, China
| | - Shu Su
- Department of Epidemiology and Biostatistics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hangting Liu
- China–Australia Joint Research Centre for Infectious Diseases, School of Public Health, Xi’an Jiaotong University Health Science Centre, Xi’an, China
| | - Lei Zhang
- China–Australia Joint Research Centre for Infectious Diseases, School of Public Health, Xi’an Jiaotong University Health Science Centre, Xi’an, China
- Central Clinical School, Faculty of Medicine, Monash University, Melbourne, VIC, Australia
- Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Wai-Kay Seto
- Department of Medicine, The University of Hong Kong–Shenzhen Hospital, Shenzhen, China
- Department of Medicine and State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong
| | - William C.W. Wong
- Department of Family Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
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Wang X, Du Z, Wang Y, Wang J, Huang S, Wang Y, Gu J, Deng W, Gilmour S, Li J, Hao Y. Impact and Cost-Effectiveness of Biomedical Interventions on Adult Hepatitis B Elimination in China: A Mathematical Modelling Study. J Epidemiol Glob Health 2023; 13:517-527. [PMID: 37349664 PMCID: PMC10469118 DOI: 10.1007/s44197-023-00132-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/30/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND China has one of the highest hepatitis B virus (HBV) disease burdens worldwide and tracking progress toward the 2030 HBV elimination targets is essential. This study aimed to assess the impact of biomedical interventions (i.e., adult vaccination, screening and treatment) on the adult HBV epidemic, estimate the time for HBV elimination, and evaluate the cost-effectiveness of the interventions in China. METHODS A deterministic compartmental model was developed to project the HBV epidemic from 2022 to 2050 and estimate the time to meet elimination targets under four intervention scenarios. Cost-effectiveness was calculated using incremental cost per quality-adjusted life year (QALY) gained, i.e., average cost-effectiveness ratio (CER). RESULTS Under the status quo, there will be 42.09-45.42 million adults living with HBV in 2050 and 11.04-14.36 million HBV-related deaths cumulatively from 2022 to 2050. Universal vaccination would cumulatively avert 3.44-3.95 million new cases at a cost of US$1027-1261/QALY gained. The comprehensive strategy would cumulatively avert 4.67-5.24 million new chronic cases and 1.39-1.85 million deaths, expediting the realization of the elimination targets forward to 2049. This strategy was also cost-effective with an average CER of US$20,796-26,685/QALY and a saved healthcare cost of US$16.10-26.84 per person. CONCLUSION China is not on track to meet the elimination targets but comprehensive biomedical interventions can accelerate the realization of the targets. A comprehensive strategy is cost-effective and cost-saving, which should be promoted in primary care infrastructures. Universal adult vaccination may be appropriate in the near future considering practical feasibility.
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Affiliation(s)
- Xinran Wang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, 510080, China
- Key Laboratory of Health Informatics of Guangdong Province, Sun Yat-sen University, Guangzhou, 510080, China
| | - Zhicheng Du
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, 510080, China
- Key Laboratory of Health Informatics of Guangdong Province, Sun Yat-sen University, Guangzhou, 510080, China
| | - Yijing Wang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, 510080, China
- Key Laboratory of Health Informatics of Guangdong Province, Sun Yat-sen University, Guangzhou, 510080, China
| | - Junren Wang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Shanshan Huang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Ying Wang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, 510080, China
- Key Laboratory of Health Informatics of Guangdong Province, Sun Yat-sen University, Guangzhou, 510080, China
| | - Jing Gu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, 510080, China
- Key Laboratory of Health Informatics of Guangdong Province, Sun Yat-sen University, Guangzhou, 510080, China
- Guangzhou Joint Research Center for Disease Surveillance, Early Warning and Risk Assessment, Guangzhou, 510080, China
| | - Wanyu Deng
- College of Life Science, Shangrao Normal University, Shangrao, 334001, China
| | - Stuart Gilmour
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | - Jinghua Li
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, 510080, China.
- Key Laboratory of Health Informatics of Guangdong Province, Sun Yat-sen University, Guangzhou, 510080, China.
- Guangzhou Joint Research Center for Disease Surveillance, Early Warning and Risk Assessment, Guangzhou, 510080, China.
| | - Yuantao Hao
- Peking University Center for Public Health and Epidemic Preparedness and Response, Beijing, 100191, China.
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, 100191, China.
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Zhang L, Liu H, Zou Z, Su S, Ong JJ, Ji F, Cui F, Chan PL, Ning Q, Li R, Shen M, Fairley CK, Liu L, Seto WK, Wong WC. Shared-care models are highly effective and cost-effective for managing chronic hepatitis B in China: reinterpreting the primary care and specialty divide. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 35:100737. [PMID: 37424676 PMCID: PMC10326699 DOI: 10.1016/j.lanwpc.2023.100737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 03/22/2023]
Abstract
BACKGROUND We evaluate the impact and cost-effectiveness of shared primary-specialty chronic hepatitis B (CHB) care models in China. METHODS We constructed a decision-tree Markov model to simulate hepatitis B virus (HBV) disease progression in a cohort of 100,000 CHB individuals aged ≥18 years over their lifetime (aged 80). We evaluated the population impacts and cost-effectiveness in three scenarios: (1) status quo; (2) shared-care model with HBV testing and routine CHB follow-ups in primary care and antiviral treatment initiation in specialty care; and (3) shared-care model with HBV testing, treatment initiation and routine CHB follow-up in primary care and treatment for predetermined conditions in specialty care. We evaluated from a healthcare provider's perspective with 3% discounting rate and a willingness-to-pay (WTP) threshold of 1-time China's GDP. FINDINGS Compared with status quo, scenario 2 would result in an incremental cost of US$5.79-132.43m but a net gain of 328-16,993 quality-adjusted life years (QALYs) and prevention of 39-1935 HBV-related deaths over cohort's lifetime. Scenario 2 was not cost-effective with a WTP of 1-time GDP per capita, but became cost-effective when treatment initiation rate increased to 70%. In contrast, compared with status quo, secnario 3 would save US$144.59-192.93m in investment and achieve a net gain of 23,814-30,476 QALYs and prevention of 3074-3802 HBV-related deaths. Improving HBV antiviral treatment initiation among eligible CHB individuals substantially improved the cost-effectiveness of the shared-care models. INTERPRETATION Shared-care models with HBV testing, follow up and referring of predetermined conditions to specialty care at an appropriate time, especially antiviral treatment initiation in primary care, are highly effective and cost-effective in China. FUNDING National Natural Science Foundation of China.
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Affiliation(s)
- Lei Zhang
- China–Australia Joint Research Centre for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
- Central Clinical School, Faculty of Medicine, Monash University, Melbourne, VIC, Australia
- Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Hanting Liu
- China–Australia Joint Research Centre for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Zhuoru Zou
- China–Australia Joint Research Centre for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Shu Su
- Clinical Research Management Office, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jason J. Ong
- China–Australia Joint Research Centre for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
- Central Clinical School, Faculty of Medicine, Monash University, Melbourne, VIC, Australia
| | - Fanpu Ji
- Department of Infectious Diseases, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Fuqiang Cui
- School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, China
| | - Po-lin Chan
- Division of Communicable Disease, World Health Organization Western Pacific Regional Office, Manila, Philippines
| | - Qin Ning
- Department and Institute of Infectious Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rui Li
- China–Australia Joint Research Centre for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Mingwang Shen
- China–Australia Joint Research Centre for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, Shaanxi, China
| | - Christopher K. Fairley
- Central Clinical School, Faculty of Medicine, Monash University, Melbourne, VIC, Australia
- Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Lan Liu
- Chinese Medical Association Publishing House, 69 Dongheyanjie Street, XiCheng District, Beijing, China
| | - Wai-Kay Seto
- Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Medicine, School of Clinical Medicine and State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong, China
| | - William C.W. Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong–Shenzhen Hospital, Shenzhen, China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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Schmit N, Nayagam S, Lemoine M, Ndow G, Shimakawa Y, Thursz MR, Hallett TB. Cost-effectiveness of different monitoring strategies in a screening and treatment programme for hepatitis B in The Gambia. J Glob Health 2023; 13:04004. [PMID: 36655869 PMCID: PMC9853089 DOI: 10.7189/jogh.13.04004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background Clinical management of chronic hepatitis B virus (HBV) infection is complex and access to antiviral treatment remains limited in sub-Saharan Africa. International guidelines recommend monitoring at least annually for disease progression among HBV-infected people not meeting treatment criteria at initial diagnosis. This study aimed to assess the impact and cost-effectiveness of alternative strategies for monitoring. Methods We used a mathematical model of HBV transmission and natural history, calibrated to all available West African data, to project the population-level health impact, costs and cost-effectiveness of different monitoring strategies for HBV-infected individuals not initially eligible for antiviral treatment. We assumed that these patients were found in the year 2020 in a hypothetical community-based screening programme in The Gambia. Monitoring frequencies were varied between every 5 and every 1 year and targeted different age groups. Results The currently recommended annual monitoring frequency was likely to be not cost-effective in comparison with other strategies in this setting. 5-yearly monitoring in 15-45-year olds, at US$338 per disability-adjusted life year averted, had the highest probability of being the most effective cost-effective monitoring strategy. Conclusions Monitoring less frequently than once a year is a cost-effective strategy in a community-based HBV screening and treatment programme in The Gambia, with the optimal strategy depending on the cost-effectiveness threshold. Efficiencies may be gained by prioritising the 15-45-year age group for more intensive monitoring.
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Affiliation(s)
- Nora Schmit
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, UK
| | - Shevanthi Nayagam
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, UK
- Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Maud Lemoine
- Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Gibril Ndow
- Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Yusuke Shimakawa
- Unité d’Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France
| | - Mark R Thursz
- Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Timothy B Hallett
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, UK
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Toy M, Hutton D, Jia J, So S. Costs and health impact of delayed implementation of a national hepatitis B treatment program in China. J Glob Health 2022; 12:04043. [PMID: 35796158 PMCID: PMC9260492 DOI: 10.7189/jogh.12.04043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Hepatitis B virus (HBV) infection is a leading public health problem in China. COVID-19 pandemic has interrupted the delivery of health care interventions worldwide, including HBV infection control. Methods In this study, we used a Markov model to quantify the costs and population health impact of HBV treatment in China for the following scenarios: 1) current practice with only 17% of treatment eligible HBV infected adults receiving antiviral treatment; 2) reaching the World Health Organization (WHO) treatment target of 80% by 2030 with a steady increase in treatment rate beginning in 2022; and 3) the effect of a 1-5-year delay in meeting the 2030 WHO treatment target. A one-way as well as a probabilistic sensitivity analysis were conducted. Results Without increasing antiviral treatment for treatment eligible HBV infected adults, the life-time health care costs for the estimated 89.2 million adults living with HBV in China is US$1305 billion and 10.8 million (12%) will die from HBV-related liver disease. Increasing treatment to achieve the WHO 80% target by 2030 would save US$472 billion and prevent 3.3 million HBV-related deaths. We estimated that a 1-year delay beyond 2030 in reaching the WHO 80% treatment target would likely lead to US$55 billion increase in future health care costs, and an additional 334 000 future deaths from HBV-related liver disease or cancer. Conclusions Reaching the WHO 2030 with minimal delays would have an immense health and economic benefit. Implementing a national treatment program for HBV in China should be a key priority for policymakers.
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Affiliation(s)
- Mehlika Toy
- Asian Liver Center, Department of Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - David Hutton
- Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan, USA
| | - Jidong Jia
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Samuel So
- Asian Liver Center, Department of Surgery, Stanford University School of Medicine, Palo Alto, California, USA
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9
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Yang N, Lei L, Meng Y, Zhou N, Shi L, Hu M. Cost-Benefit Analysis of Vaccination Strategies to Prevent Mother-to-Child Transmission of the Hepatitis B Virus Using a Markov Model Decision Tree. Front Public Health 2022; 10:662442. [PMID: 35801242 PMCID: PMC9256498 DOI: 10.3389/fpubh.2022.662442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Currently, in China, several strategies exist to prevent mother-to-child transmission (MTCT) of the hepatitis B virus (HBV). These include providing Hepatitis B vaccination and hepatitis B immunoglobulin (HBIG) injection with different types of administration and dosages. The aim of this study is threefold: first, to evaluate the economic viability of current hepatitis B vaccination strategies for preventing MTCT from a public health policy perspective; second, to optimize the current immunization strategy for preventing perinatal transmission of the HBV; and third, to offer policy options to the National Health Commission in China. Methods To simulate the disease outcome for the entire life of newborns infected with HBV, a Markov model with eight possible health states was built by using TreeAge Pro 2011 software. In the present study, the model parameters were probability and cost, which were extracted from literature and calculated using Microsoft Excel 2013. The optimal immunization strategies were identified through cost-benefit analyses. A benefit-cost ratio (BCR) > 1 indicated that the strategy had positive benefits and vice versa. A one-way sensitivity analysis was used to investigate the stability of the results. Results From a public health care system perspective, we evaluated the economic viability of 11 strategies in China. For all 11 strategies, the BCR was > 1, which indicated that the benefits of all the strategies were greater than the costs. We recommended strategy number 9 as being optimal. In strategy number 9, babies born to hepatitis B surface antigen (HBsAg)-positive mothers were given an HBIG (200 IU) within 24 h of birth and three injections of hepatitis -B vaccine (20-μg each) at 0, 1, and 6 months, and the strategy had a BCR of 4.61. The one-way sensitivity analysis revealed that the full vaccination coverage and effective rates of protection were two factors that greatly influenced the BCR of the different prevention strategies; other factors had little effect. Conclusion The benefits of all strategies were greater than the costs. For decision-making and application, the strategy should be based on local socio-economic conditions so that an appropriate immunization strategy can be selected.
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Affiliation(s)
- Nan Yang
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Lei Lei
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Yiyu Meng
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Naitong Zhou
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Lizheng Shi
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Ming Hu
- West China School of Pharmacy, Sichuan University, Chengdu, China
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10
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Toy M, Hutton D, McCulloch K, Romero N, Revill PA, Penicaud MC, So S, Cowie BC. The price tag of a potential cure for chronic hepatitis B infection: A cost threshold analysis for USA, China and Australia. Liver Int 2022; 42:16-25. [PMID: 34328697 DOI: 10.1111/liv.15027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 07/15/2021] [Accepted: 07/27/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS We aim to capture the economic impact of a potential cure for chronic hepatitis B infection (CHB) in three countries (USA, China and Australia) with different health systems and epidemics to estimate the threshold drug prices below which a CHB cure would be cost-saving and/or highly cost-effective. METHODS We simulated patients' hepatitis B progression, under three scenarios: current long-term suppressive antiviral therapy, functional cure defined as sustained undetectable HBsAg and HBV DNA, and partial cure defined as sustained undetectable HBV DNA only after a finite, 48-week treatment. RESULTS Compared with current long-term antiviral therapy, a 30% effective functional cure among patients with and without cirrhosis in the USA, China and Australia would yield 17.50, 17.32 and 20.42 QALYs per patient, and 20.61, 20.42 and 20.62 QALYs per patient respectively. In financial terms, for CHB patients with and without cirrhosis, this would be cost-saving at a one-time treatment cost under US$11 944 and US$6694, respectively, in the USA, US$1744 and US$1001 in China, and US$12 063 and US$10 983 in Australia. CONCLUSION We show that in purely economic terms, a CHB cure will be highly cost-effective even if effective in only 30% of treated patients. The threshold price for cure is largely determined by the current antiviral drug costs, since it will replace a daily antiviral pill that is inexpensive and effective, although not curative. The likely need for combination therapies to achieve cure will also present cost challenges. While cost-effectiveness is important, it cannot be the only consideration, as cure will provide many benefits in addition to reduced liver disease and HCC, including eliminating the need for a long-term daily pill and reducing stigma often associated with chronic viral infection.
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Affiliation(s)
- Mehlika Toy
- Asian Liver Center, Department of Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - David Hutton
- Department of Health Management and Policy, University of Michigan, Ann Harbor, MI, USA
| | - Karen McCulloch
- WHO Collaborating Centre for Viral Hepatitis, Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,Epidemiology Unit, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Nicole Romero
- WHO Collaborating Centre for Viral Hepatitis, Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,Department of Medicine (Royal Melbourne Hospital), Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter A Revill
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,Department of Microbiology and Immunology, University of Melbourne, Parkville, Victoria, Australia
| | - M-Capucine Penicaud
- The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Samuel So
- Asian Liver Center, Department of Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Benjamin C Cowie
- WHO Collaborating Centre for Viral Hepatitis, Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,Department of Medicine (Royal Melbourne Hospital), Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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11
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Li R, Lin X, Wang JY, Wang X, Lu J, Liu Y, Cao Z, Ren S, Ma L, Jin Y, Zheng S, Hu Z, Wang L, Chen X. Cost-effectiveness of combination antiviral treatment with extended duration for hepatitis B e antigen (HBeAg)-negative chronic hepatitis B in China. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1365. [PMID: 34733917 PMCID: PMC8506536 DOI: 10.21037/atm-21-1666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/23/2021] [Indexed: 12/30/2022]
Abstract
Background Hepatitis B surface antigen clearance or seroconversion is rarely achieved for patients using nucleoside analogs or pegylated interferon alpha monotherapy approaches. Several recent studies have confirmed the benefit of a combination of these two approaches for selected chronic hepatitis B patients. However, few reports have investigated long-term outcomes or health economic evaluation for hepatitis B surface antigen clearance. The aim of this study was to perform a cost-effectiveness analysis of the long-term use of this combination strategy among selected hepatitis B e antigen-negative patients. Methods Drawing on experience in China, we used a Markov model to simulate disease progression among a population of hepatitis B e antigen-negative chronic hepatitis B patients with surface antigen levels of ≤1,000 IU/mL through a discrete series of health states. We compared nucleoside analog monotherapy to the combination strategy over a prolonged period. We measured lifetime costs, quality-adjusted life-years and incremental cost-effectiveness ratios. Results The combination therapy produced 15.8 quality-adjusted life-years, and cost US dollars (USD) 45,032 per patient. The monotherapy gave 13.9 quality-adjusted life-years, and had a cost of USD 52,064. The incremental cost-effectiveness ratio of the monotherapy (USD −3,755 per quality-adjusted life-year) did not obtain extended dominance over combination therapy. The most cost-effective option was combination therapy among patients with hepatitis B surface antigen levels of ≤10 IU/mL, which had the lowest calculated cost of USD 35,318 and most quality-adjusted life-years (16.7). Conclusions A long-term combination treatment strategy for selected hepatitis B e antigen-negative chronic hepatitis B patients may prolong quality-adjusted life-years compared with nucleoside analog monotherapy. Chronic hepatitis B patients with a hepatitis B surface antigen level of ≤10 IU/mL were the most cost-effective population under this strategy.
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Affiliation(s)
- Runqin Li
- The First Unit, Department of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Xiao Lin
- The First Unit, Department of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Jing-Yue Wang
- Division of Hepatology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xiaomo Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Junfeng Lu
- The First Unit, Department of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yali Liu
- The Third Unit, Department of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Zhenhuan Cao
- The First Unit, Department of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Shan Ren
- The First Unit, Department of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Lina Ma
- The First Unit, Department of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yi Jin
- The First Unit, Department of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Sujun Zheng
- The First Unit, Department of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Zhongjie Hu
- The First Unit, Department of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Li Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Xinyue Chen
- The First Unit, Department of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
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12
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Duan M, Chi X, Xiao H, Liu X, Zhuang H. High-normal alanine aminotransferase is an indicator for liver histopathology in HBeAg-negative chronic hepatitis B. Hepatol Int 2021; 15:318-327. [PMID: 33638049 DOI: 10.1007/s12072-021-10153-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/30/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVE We aimed to assess liver histological changes of HBeAg-negative chronic hepatitis B (CHB) patients with normal ALT, and determined the association between significant liver injury and age, ALT, and HBV DNA levels. METHODS We retrospectively examined 327 patients who underwent liver biopsy from 2009 to 2018. Significant liver histological change is defined as liver necroinflammation ≥ G2 and/or liver fibrosis ≥ F2. RESULTS The proportion of patients with significant liver necroinflammation or fibrosis in the high-normal ALT group (ALT > 20 U/L) was higher than that in the low-normal ALT group (ALT ≤ 20 U/L) (44.6% vs 26.5%, 61.0% vs 41.7%, p < 0.01); also the proportion in the group with HBV DNA ≥ 2000 IU/mL was significantly higher than that in the group with HBV DNA < 2000 IU/mL (58.5% vs 27.1%, 67.9% vs 46.2%, p < 0.01). There was no significant difference in hepatic histopathology between < 40 and ≥ 40 years groups. Among 221 patients with normal ALT and low HBV DNA levels (< 2000 IU/mL), 27.1% of them had significant liver necroinflammation and 46.2% had significant liver fibrosis. The multiple logistic regression analysis showed that ALT > 20 U/L and HBV DNA ≥ 2000 IU/mL were independently associated with significant liver histopathology (p < 0.01). CONCLUSION HBeAg-negative CHB patients with normal ALT and low HBV DNA level (< 2000 IU/mL) were suggested to perform liver biopsy or noninvasive methods for histopathology assessment, then to be determined for antiviral therapy. ALT > 20 U/L and HBV DNA ≥ 2000 IU/mL are good independently predictive factors for evaluating significant liver histopathology for HBeAg-negative CHB patients with normal ALT. CLINICAL TRIALS REGISTRATION Chinese Clinical Trial Registry (ChiCTR-IOR-14005474).
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Affiliation(s)
- Menghui Duan
- Department of Microbiology and Center of Infectious Diseases, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, 100191, China
| | - Xiaoling Chi
- Traditional Chinese Medicine Hospital of Guangdong Province, Guangzhou, 510120, China
| | - Huanming Xiao
- Traditional Chinese Medicine Hospital of Guangdong Province, Guangzhou, 510120, China
| | - Xueen Liu
- Department of Microbiology and Center of Infectious Diseases, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, 100191, China.
| | - Hui Zhuang
- Department of Microbiology and Center of Infectious Diseases, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, 100191, China.
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13
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Abstract
Chronic hepatitis B (CHB) remains a global healthcare burden. Although the recent developments in the field have led to a reduction in incidence, the morbidity and mortality including liver cirrhosis and hepatocellular carcinoma (HCC) remain a formidable challenge. Advances in understanding the immunopathogenesis of CHB have led to a recent change in clinical categorization. EASL introduced the term hepatitis B 'e' antigen (HBeAg)-negative chronic infection, to replace the historical term 'inactive carrier' disease phase, the commonest CHB phase. Although this disease phase is associated with a favorable prognosis, it is not a truly 'inactive' disease phase with no ostensible liver disease, as inferred by the previous anachronistic terminology, and the risk of spontaneous reactivation and the potential risk of disease progression and HCC development are not negligible. Likewise, the APASL also uses the term "Incidentally Detected Asymptomatic Hepatitis B surface antigen (HBsAg)-positive Subject (IDAHS)", comprising all HBsAg-positive subjects who are incidentally detected during routine tests, without any previous or present symptoms of liver disease. This entity includes HBV infection with varied stages of liver disease. Antiviral treatment is generally reserved for patients with active inflammation and/or at risk of disease progression and HCC development. HBsAg loss is considered an optimal treatment endpoint, and may also be achievable in HBeAg-negative chronic infection and IDAHS. In light of this, and the emerging novel HBV therapies, lowering the treatment threshold and a 'Treat All' approach should now be considered. In this review, we summarize the literature and guidance on HBeAg-negative chronic infection, and we make a concerted effort to present the reasons why the one-dimensional term 'inactive carrier' should be abandoned.
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14
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Mahfouz M, Nguyen H, Tu J, Diaz CR, Anjan S, Brown S, Bosire K, Carrasquillo O, Martin P, Jones PD. Knowledge and Perceptions of Hepatitis B and Hepatocellular Carcinoma Screening Guidelines Among Trainees: A Tale of Three Centers. Dig Dis Sci 2020; 65:2551-2561. [PMID: 31813133 DOI: 10.1007/s10620-019-05980-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 11/27/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatitis B (HBV), the leading cause of hepatocellular carcinoma (HCC) worldwide, disproportionately affects minorities in the USA. Undiagnosed HBV precludes HCC screening and contributes to late-stage cancer presentation and decreased survival. Barriers to HBV and HCC screening include lack of insurance and limited diffusion of guidelines. We aimed to assess knowledge about HBV and HCC screening indications and explore barriers to screening. METHODS We surveyed trainees from the University of Miami/Jackson Memorial Hospitals, Palmetto General Hospital, and Mount Sinai Medical Center. We assessed knowledge using clinical vignettes. We performed bivariate and Chi-squared analyses. RESULTS There were 183 respondents; median age was 31 and 52% were male. The sample was 35% Hispanic, 29% White, 18% Asian, and 9% Black. Training department was Internal Medicine, 71%; Family Medicine, 11%; Infectious Diseases, 6%; or Gastroenterology, 7%. Only 59% correctly estimated national HBV prevalence; 25% correctly estimated global prevalence. In vignettes with behavioral risk factors, trainees correctly advised screening, 63-96%. However, when the risk factor was the birthplace, correct responses ranged from 33 to 53%. Overall, 45% chose an incorrect combination of HBV screening tests. Perceived barriers to screening included limited expertise in screening of immigrants and limited patient education. Respondents were more likely to recommend HCC screening in cirrhotic patients versus non-cirrhotic HBV patients. Key barriers to HCC screening included uncertainty about HCC guidelines and patient financial barriers. CONCLUSIONS Knowledge of HBV and HCC screening recommendations is suboptimal among trainees. Efforts to broadly disseminate HBV and HCC guidelines through targeted educational interventions are needed.
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Affiliation(s)
- Mahmoud Mahfouz
- Department of Medicine, Mount Sinai Medical Center, Miami, USA
| | - Harry Nguyen
- Department of Medicine, Palmetto General Hospital, Hialeah, USA
| | - Jonathan Tu
- University of Miami Miller School of Medicine, Miami, USA
| | - Carlos R Diaz
- Department of Medicine, University of Miami Miller School of Medicine, Miami, USA.,Jackson Memorial Hospital, Miami, USA
| | - Shweta Anjan
- Department of Medicine, Infectious Diseases Division, University of Miami Miller School of Medicine, Miami, USA
| | - Stefanie Brown
- Department of Medicine, University of Miami Miller School of Medicine, Miami, USA
| | - Kassandra Bosire
- Department of Family Medicine, University of Miami Miller School of Medicine, Miami, USA
| | - Olveen Carrasquillo
- Department of Medicine, University of Miami Miller School of Medicine, Miami, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, USA
| | - Paul Martin
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, USA.,Department of Medicine, Division of Digestive Health and Liver Diseases, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Patricia D Jones
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, USA. .,Department of Medicine, Division of Digestive Health and Liver Diseases, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA.
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15
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Zheng Y, Wu J, Ding C, Xu K, Yang S, Li L. Disease burden of chronic hepatitis B and complications in China from 2006 to 2050: an individual-based modeling study. Virol J 2020; 17:132. [PMID: 32859216 PMCID: PMC7455911 DOI: 10.1186/s12985-020-01393-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 08/03/2020] [Indexed: 02/08/2023] Open
Abstract
Background Chronic hepatitis B has become a major public health problem in China. An accurate depiction of the disease burden has not yet been thoroughly conducted. We aimed to project the disease burden of chronic hepatitis B virus (HBV) infection and related complications by modeling various scenarios. Method An individual-based Markov model was used to predict disease burden from 2006 through 2050. We simulated 5 scenarios with different annual incidences, diagnoses and nucleotide analog (NA) treatment rates as well as treatment eligibility, which included a natural history without diagnosis or NA therapy, a base case, a World Health Organization (WHO)-proposed target case and two ideal cases. Result The natural history scenario is projected to have the fewest HBsAg losses (27.59 million) and highest number of HBV-related deaths (27.19 million). With improved diagnosis and treatment rates of NA therapy, ideal cases have fewer HBV-related deaths (14.46–14.77 million) than do WHO-proposed cases (15.13 million) and base cases (16.89 million), but the proportion of HBsAg loss is similar among them. With a reduction in new infections, the prevalence of chronic HBV in 2050 is expected to be a minimum of 27.03–27.49 million under WHO and ideal cases. Conclusion Ideal scenarios 1 and 2 contribute to the lowest disease burden of HBV and its complications in the future, in which new infection control is more effective than increasing diagnosis, treatment rate and treatment eligibility. However, considering the large existing chronic HBV infected population and the low HBsAg loss rate of NA therapy, it is still difficult to avert the increasing trend of cumulative cirrhosis, DC, HCC, LT, and HBV-related death in all scenarios. If new high-potency drugs are not developed, the disease burden of chronic HBV will remain high in the future.
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Affiliation(s)
- Yang Zheng
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Jie Wu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Cheng Ding
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Kaijin Xu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Shigui Yang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Lanjuan Li
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China.
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16
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Tordrup D, Hutin Y, Stenberg K, Lauer JA, Hutton DW, Toy M, Scott N, Bulterys M, Ball A, Hirnschall G. Additional resource needs for viral hepatitis elimination through universal health coverage: projections in 67 low-income and middle-income countries, 2016-30. LANCET GLOBAL HEALTH 2019; 7:e1180-e1188. [PMID: 31353061 DOI: 10.1016/s2214-109x(19)30272-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/17/2019] [Accepted: 05/01/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The World Health Assembly calls for elimination of viral hepatitis as a public health threat by 2030 (ie, -90% incidence and -65% mortality). However, WHO's 2017 cost projections to achieve health-related Sustainable Development Goals did not include the resources needed for hepatitis testing and treatment. We aimed to estimate the incremental commodity cost of adding scaled up interventions for testing and treatment of hepatitis to WHO's investment scenarios. METHODS We added modelled costs for implementing WHO recommended hepatitis testing and treatment to the 2017 WHO cost projections. We quantified additional requirements for diagnostic tests, medicines, health workers' time, and programme support across 67 low-income and middle-income countries, from 2016-30. A progress scenario scaled up interventions and a more ambitious scenario was modelled to reach elimination by 2030. We used 2018 best available prices of diagnostics and generic medicines. We estimated total costs and the additional investment needed over the projection of the 2016 baseline cost. FINDINGS The 67 countries considered included 230 million people living with hepatitis B virus (HBV) and 52 million people living with hepatitis C virus (HCV; 90% and 73% of the world's total, respectively). Under the progress scenario, 3250 million people (2400 million for HBV and 850 million for HCV) would be tested and 58·2 million people (24·1 million for HBV and 34·1 million for HCV) would be treated (total additional cost US$ 27·1 billion). Under the ambitious scenario, 11 631 million people (5502 million for HBV and 6129 million for HCV) would be tested and 93·8 million people (32·2 million for HBV and 61·6 million for HCV) would be treated (total additional cost $58·7 billion), averting 4·5 million premature deaths and leading to a gain of 51·5 million healthy life-years by 2030. However, if affordable HCV medicines remained inaccessible in 13 countries where medicine patents are protected, the additional cost of the ambitious scenario would increase to $118 billion. Hepatitis elimination would account for a 1·5% increase to the WHO ambitious health-care strengthening scenario costs, avert an additional 4·6% premature deaths, and add an additional 9·6% healthy life-years from 2016-30. INTERPRETATION Access to affordable medicines in all countries will be key to reach hepatitis elimination. This study suggests that elimination is feasible in the context of universal health coverage. It points to commodities as key determinants for the overall price tag and to options for cost reduction strategies. FUNDING WHO, United States Centers for Disease Control and Prevention, Unitaid.
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Affiliation(s)
- David Tordrup
- WHO Collaborating Centre for Pharmaceutical Policy and Regulation, University of Utrecht, Utrecht, Netherlands; Department of HIV and Global Hepatitis Programme, and Department of Health Systems Governance and Financing, WHO, Geneva, Switzerland
| | - Yvan Hutin
- Department of HIV and Global Hepatitis Programme, and Department of Health Systems Governance and Financing, WHO, Geneva, Switzerland.
| | - Karin Stenberg
- Department of HIV and Global Hepatitis Programme, and Department of Health Systems Governance and Financing, WHO, Geneva, Switzerland
| | - Jeremy A Lauer
- Department of HIV and Global Hepatitis Programme, and Department of Health Systems Governance and Financing, WHO, Geneva, Switzerland
| | - David W Hutton
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Mehlika Toy
- School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Nick Scott
- Burnet Institute, Melbourne, VIC, Australia
| | - Marc Bulterys
- Department of HIV and Global Hepatitis Programme, and Department of Health Systems Governance and Financing, WHO, Geneva, Switzerland
| | - Andrew Ball
- Department of HIV and Global Hepatitis Programme, and Department of Health Systems Governance and Financing, WHO, Geneva, Switzerland
| | - Gottfried Hirnschall
- Department of HIV and Global Hepatitis Programme, and Department of Health Systems Governance and Financing, WHO, Geneva, Switzerland
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17
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Economic Analyses to Inform and Support Health Policy for Chronic Hepatitis B Treatment. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s11901-019-00482-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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18
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Tsou HH, Yang HC, Hsiao CF, Hsiung CA, Liu TW, Chuang MH, Wu HY, Hsu YT, Tsui CW, Chen PJ, Cheng AL, Hsu C. Cost-effectiveness of preventing hepatitis B virus reactivation in patients with lymphoma and resolved HBV infection. J Formos Med Assoc 2019; 119:335-344. [PMID: 31235201 DOI: 10.1016/j.jfma.2019.05.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/08/2019] [Accepted: 05/29/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND/PURPOSE Hepatitis B virus (HBV) reactivation may occur in >10% of patients with lymphoma and resolved HBV infection who undergo rituximab-containing chemotherapy. Preventive strategies may have marked impact on resource allocation in HBV endemic areas. This study aims to compare the cost-effectiveness between prophylactic antiviral therapy and HBV DNA monitoring for the prevention of HBV-related complications. METHODS Data sources are studies of HBV-related events and survival for patients with lymphoma and resolved HBV infection published since 2006. Decision tree analysis was used to compare the incremental cost-effectiveness ratio (ICER) of preventing HBV-related death or liver decompensation for patients who undergo first-line rituximab-containing chemotherapy. Sensitivity analysis was performed to examine the impact of the preventive efficacy, the duration of prophylactic antiviral therapy, and the cost of different interventions. The direct medical cost was derived from the database of the NHI Administration, Taiwan. The time frame of our analysis was set to 3 years after the completion of chemotherapy. RESULTS The median ICER of prophylactic antiviral therapy, according to current practice guidelines, ranged between USD 150,000 and 250,000 if we apply the guidelines generally. When a long-course (12 months after completion of chemotherapy according to clinical guidelines) prophylactic therapy was assumed, Option A was cheaper and more effective only in the anti-HBs-negative subgroup (median ICER US$149,932 vs. US$161,526, p = 0.013). CONCLUSION Identification of anti-HBs-negative subgroups is critical to improve the cost-effectiveness of prophylactic antiviral therapy in lymphoma patients with resolved HBV infection.
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Affiliation(s)
- Hsiao-Hui Tsou
- Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan; Graduate Institute of Biostatistics, College of Public Health, China Medical University, Taichung, Taiwan
| | - Hung-Chih Yang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chin-Fu Hsiao
- Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan; Division of Clinical Trial Statistics, Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Chao A Hsiung
- Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Tsang-Wu Liu
- National Institute of Cancer Research, National Health Research Institutes, Miaoli, Taiwan
| | - Mei-Hsing Chuang
- Division of Clinical Trial Statistics, Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Hsiao-Yu Wu
- Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Ya-Ting Hsu
- Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Chiung-Wen Tsui
- Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Pei-Jer Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Ann-Lii Cheng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Oncology, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Taiwan; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chiun Hsu
- Department of Oncology, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Taiwan; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan.
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19
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Cheung KW, Seto MTY, Wong D, Mak ASL, So PL, Lau WL, Wang W, Kan ASY, Lee CP, Ng EHY. Pattern and predictors of medical care received by hepatitis B carriers during pregnancy and after delivery. Public Health 2019; 168:36-42. [PMID: 30685596 DOI: 10.1016/j.puhe.2018.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 11/11/2018] [Accepted: 12/13/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The objective of the study is to evaluate the pattern and predictors of medical care received by hepatitis B virus (HBV) carriers during pregnancy and after delivery in Hong Kong. STUDY DESIGN The study is a retrospective analysis. METHODS Pregnant HBV carriers and their infants were followed up for 9-12 months after delivery. Face-to-face interviews were conducted to investigate what medical care they received for HBV before, during and after pregnancy. RESULTS Data were available for 412 HBV carriers. A total of 375 (91.0%) women were known HBV carriers before pregnancy. Routine antenatal screening picked out the remaining 37 (9.0%) HBV carriers; these women were younger, more likely to be smokers and had a lower level of education (P < 0.05) than known HBV carriers. In total, 356 of 412 (86.4%) HBV carriers did not receive any medical care for HBV during pregnancy. Known HBV carrier status, history of medical check-up and the use of antiviral treatment before pregnancy were significant predictors for HBV medical care during pregnancy (P < 0.05). The results show that 217 of 412 (52.6%) HBV carriers did not receive medical care for HBV after delivery. HBV medical care before pregnancy, use of antiviral treatment before pregnancy and a higher level of education were significant predictors for postpartum HBV medical care (P < 0.05). Multivariate analysis showed that HBV medical care before pregnancy (odds ratio [OR], 7.73; 95% confidence interval [CI], 3.21-18.65; P < 0.001) and the use of antiviral treatment (OR, 5.02; 95% CI, 1.41-17.81; P = 0.013) were associated with medical care during pregnancy. Medical care before pregnancy was also associated with postpartum HBV medical care (OR, 5.05; 95% CI, 3.29-7.51; P < 0.001). CONCLUSIONS A significant proportion of HBV carriers did not receive HBV-related medical check-ups during and after pregnancy in Hong Kong despite the majority being aware of their carrier status. Medical care before pregnancy predicted antenatal and postpartum HBV medical care.
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Affiliation(s)
- K W Cheung
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region.
| | - M T Y Seto
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region
| | - D Wong
- Department of Obstetrics & Gynaecology, Pamela Youde Nethersole Eastern Hospital, Hong Kong Special Administrative Region
| | - A S L Mak
- Department of Obstetrics & Gynaecology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region
| | - P L So
- Department of Obstetrics & Gynaecology, Tuen Mun Hospital, Hong Kong Special Administrative Region
| | - W L Lau
- Department of Obstetrics & Gynaecology, Kwong Wah Hospital, Hong Kong Special Administrative Region
| | - W Wang
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region
| | - A S Y Kan
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region
| | - C P Lee
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region
| | - E H Y Ng
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region
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20
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Kong Q, Han J, Deng H, Wu F, Guo S, Ye Z. miR-431-5p alters the epithelial-to-mesenchymal transition markers by targeting UROC28 in hepatoma cells. Onco Targets Ther 2018; 11:6489-6503. [PMID: 30323624 PMCID: PMC6177384 DOI: 10.2147/ott.s173840] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE MicroRNA (miR)-431 plays an essential role in various human cancer types, particularly in the process of invasion. However, the function and mechanism of miR-431-5p in the invasion of hepatocellular carcinoma (HCC) remain undefined. METHODS The expression levels of miR-431-5p and its potential target protein UROC28 in hepatocellular carcinoma cells and tissues were detected, and the levels of EMT markers in vivo and in vitro were also detected. RESULTS MiR-431-5p was downregulated in HCC cell lines and tissues and associated with vascular invasion and tumor encapsulation. Furthermore, miR-431-5p was able to influence the epithelialto-mesenchymal transition (EMT) process in HCCLM3 and HUH7 cells. Mechanistically, it was discovered that miR-431-5p repressed invasion by targeting UROC28. Furthermore, miR-431-5p influenced the EMT markers in HCCLM3 and HUH7 cells by downregulating UROC28 expression. Similarly, in vivo assays confirmed that miR-431-5p upregulation in HCC cells remarkably inhibited tumor proliferation and influenced the EMT markers. CONCLUSION The current study has demonstrated that the miR-431-5p/UROC28 axis acts possible influence on the EMT in HCC. Upregulation of miR-431-5p could be an original approach for inhibiting tumor invasion.
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Affiliation(s)
- Qinglei Kong
- Department of Emergency, The Third Affiliated Hospital of Sun Yat-San University, Guangzhou 510630, China,
| | - Jianhua Han
- Department of Emergency, The Third Affiliated Hospital of Sun Yat-San University, Guangzhou 510630, China,
| | - Hong Deng
- Department of Infectious Disease and Clinical Laboratory, The Third Affiliated Hospital of Sun Yat-San University, Guangzhou 510630, China
| | - Feilong Wu
- Department of Emergency, The Third Affiliated Hospital of Sun Yat-San University, Guangzhou 510630, China,
| | - Shaozhong Guo
- Department of Infectious Disease and Clinical Laboratory, The Third Affiliated Hospital of Sun Yat-San University, Guangzhou 510630, China
| | - Zhiqiang Ye
- Department of Emergency, The Third Affiliated Hospital of Sun Yat-San University, Guangzhou 510630, China,
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21
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Lin H, Yang B, Teng M. T-cell immunoglobulin mucin-3 as a potential inducer of the epithelial-mesenchymal transition in hepatocellular carcinoma. Oncol Lett 2017; 14:5899-5905. [PMID: 29113224 PMCID: PMC5661575 DOI: 10.3892/ol.2017.6961] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 04/26/2017] [Indexed: 12/13/2022] Open
Abstract
T-cell immunoglobulin mucin (TIM)-3 is an important member of the TIM gene family, which was thought to contribute to the progression of numerous types of cancer, including hepatocellular carcinoma (HCC); however, the mechanism underlying TIM-3 functions in HCC progression has not yet been extensively investigated. The present study aimed to investigate the function of TIM-3 in the metastasis of HCC and to determine whether the alteration of TIM-3 expression levels regulated the epithelial-mesenchymal transition (EMT) occurrence of HCC, using epithelial (E)-cadherin, neuronal (N)-cadherin, matrix metallopeptidase-9 (MMP-9), Twist 1, Slug, Snail, and Smad as EMT biomarkers. The results demonstrated that upregulation of TIM-3 using TIM-3 lentiviral activation particles (5 µl) increased cell migration and invasion, which was decreased in TIM-3 short interfering RNA-infected cells (10 µM, 3 µl) correspondingly. SMMC-7721 HCC cells were used as the control. EMT was aggravated in TIM-3 upregulated SMMC-7721 cells, which was attenuated in the TIM-3 interference group, accompanied by an alteration of E-cadherin, N-cadherin, MMP-9, Twist 1, Slug, Snail and Smad expression levels. The data presented suggests that TIM-3 serves an essential role in the metastasis of HCC, the mechanism of which was associated with EMT occurrence. Interference of TIM-3 is expected to be an effective means to prevent and control EMT, and further the metastasis of HCC.
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Affiliation(s)
- Huapeng Lin
- Department of Hepatobiliary Surgery, Qianfoshan Hospital Affiliated to Shandong University, Jinan, Shandong 250014, P.R. China.,Department of Hepatobiliary Surgery, Jining No. 1 People's Hospital, Jining, Shandong 272001, P.R. China
| | - Bin Yang
- Department of Hepatobiliary and Vascular Surgery, Jining No. 1 People's Hospital, Jining, Shandong 272001, P.R. China
| | - Mujian Teng
- Department of Hepatobiliary Surgery, Qianfoshan Hospital Affiliated to Shandong University, Jinan, Shandong 250014, P.R. China
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22
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Chinnaratha MA, Kaambwa B, Woodman RJ, Fraser RJ, Wigg AJ. Assessing the clinical and economic impact of increasing treatment uptake in chronic hepatitis B infection using a Markov model. J Gastroenterol Hepatol 2017; 32:1370-1377. [PMID: 28002881 DOI: 10.1111/jgh.13679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 11/22/2016] [Accepted: 12/12/2016] [Indexed: 12/14/2022]
Abstract
UNLABELLED Treatment uptake in chronic hepatitis B virus (HBV) infection is low in South Australia, and the cost-effectiveness of increasing treatment uptake rates in this population has not been assessed. AIMS AND METHODS Using a cohort Markov model, cost-effectiveness was assessed for three different treatment uptake scenarios: 2.9% (current level-scenario 1), 10% (scenario 2), and 15% (scenario 3). The initial HBV population included 2550 treatment eligible patients who transitioned between six different health states over a 10-year period. Treatment transition probabilities were based on tenofovir therapy, while those not assigned to treatment followed the natural history transition probabilities. We estimated the incremental cost per quality adjusted life year gained using the prevented number of deaths, hepatocellular carcinoma, and liver transplants. RESULTS Scenario 3 was associated with the lowest mean cost/person over 10 years (AU$60 133), compared with scenario 2 (AU$61 964) and scenario 1 (AU$64 597). Scenario 3 was also associated with the highest quality adjusted life year gained (8.196) compared with scenario 2 (7.985) and scenario 1 (7.684). Scenario 3 would result in 50% reduction in hepatocellular carcinoma and 30% reduction in HBV-related mortality compared with scenario 1, over a 10-year period. Higher treatment uptake was found to be cost-effective with at least 2 years of treatment at either 10% or 15% of the target population. CONCLUSION Maximizing the treatment uptake in the existing HBV population from 2.9% to 15% was cost-effective for periods of 2 years or more. This was due to a reduction in the number of expected clinical events.
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Affiliation(s)
- Mohamed A Chinnaratha
- Hepatology and Liver Transplantation Medicine Unit, Flinders Medical Centre, Bedford Park, South Australia, Australia.,School of Medicine, Flinders University, Bedford Park, South Australia, Australia
| | - Billingsley Kaambwa
- Flinders Health Economics Group, Flinders University, Bedford Park, South Australia, Australia
| | - Richard J Woodman
- School of Medicine, Flinders University, Bedford Park, South Australia, Australia
| | - Robert J Fraser
- Hepatology and Liver Transplantation Medicine Unit, Flinders Medical Centre, Bedford Park, South Australia, Australia.,School of Medicine, Flinders University, Bedford Park, South Australia, Australia
| | - Alan J Wigg
- Hepatology and Liver Transplantation Medicine Unit, Flinders Medical Centre, Bedford Park, South Australia, Australia.,School of Medicine, Flinders University, Bedford Park, South Australia, Australia
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23
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Sehr MA, Joshi KD, Fontanesi JM, Wong RJ, Bitmead RR, Gish RG. Markov modeling in hepatitis B screening and linkage to care. Theor Biol Med Model 2017; 14:11. [PMID: 28521828 PMCID: PMC5437626 DOI: 10.1186/s12976-017-0057-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 05/09/2017] [Indexed: 12/23/2022] Open
Abstract
Background With up to 240 million people chronically infected with hepatitis B worldwide, including an estimated 2 million in the United States, widespread screening is needed to link the infected to care and decrease the possible consequences of untreated infection, including liver cancer, cirrhosis and death. Screening is currently fraught with challenges in both the developed and developing world. New point-of-care tests may have advantages over standard-of-care tests in terms of cost-effectiveness and linkage to care. Stochastic modeling is applied here for relative utility assessment of point-of-care tests and standard-of-care tests for screening. Methods We analyzed effects of point-of-care versus standard-of-care testing using Markov models for disease progression in individual patients. Simulations of large cohorts with distinctly quantified models permitted the assessment of particular screening schemes. The validity of the trends observed is supported by sensitivity analyses for the simulation parameters. Results Increased utilization of point-of-care screening was shown to decrease hepatitis B-related mortalities and increase life expectancy at low projected expense. Conclusions The results suggest that standard-of-care screening should be substituted by point-of-care tests resulting in improved linkage to care and decrease in long-term complications.
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Affiliation(s)
- Martin A Sehr
- Department of Mechanical and Aerospace Engineering, University of California, San Diego, 9500 Gilman Drive, MS 0411, La Jolla, CA, 92093-0411, USA
| | - Kartik D Joshi
- Midwestern University, Arizona College of Osteopathic Medicine, 19555 North 59th Avenue, Glendale, AZ, 85308, USA
| | - John M Fontanesi
- Department of Medicine, Division of General Internal Medicine, University of California, San Diego, 200 W. Arbor Drive #8415, San Diego, CA, 92103, USA
| | - Robert J Wong
- Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital, 1411 East 31st Street, Highland Care Pavilion - 5th Floor Endoscopy Unit, Oakland, CA, 94602, USA
| | - Robert R Bitmead
- Department of Mechanical and Aerospace Engineering, University of California, San Diego, 9500 Gilman Drive, MS 0411, La Jolla, CA, 92093-0411, USA
| | - Robert G Gish
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University, Alway Building, Room M211, 300 Pasteur Drive, MC: 5187, Stanford, CA, 94305-5187, USA. .,National Viral Hepatitis Roundtable, 1612 K Street NW, Suite 1202, Washington, DC, 20006, USA. .,Hepatitis B Foundation, 3805 Old Easton Road, Doylestown, PA, USA.
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24
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Chen H, Chen L. Estimating cost-effectiveness associated with all-oral regimen for chronic hepatitis C in China. PLoS One 2017; 12:e0175189. [PMID: 28380022 PMCID: PMC5381915 DOI: 10.1371/journal.pone.0175189] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 03/22/2017] [Indexed: 02/07/2023] Open
Abstract
Background All-oral regimens are associated with higher effectiveness and shorter treatment duration for chronic hepatitis C. Given its superior effect and enormous patients in China, clinicians or patients may be compelled to consider delaying treatment for all-oral regimen. Objective To estimate cost-effectiveness of delaying treatment for all-oral regimen in the subsequent years under different assumptions about their price and efficacy compared with standard of care in China. Methods A state-transition Markov model was developed to estimate lifetime costs and quality-adjusted life years (QALYs). Incremental cost-effectiveness ratio (ICER) and net monetary benefit (NB) were calculated. And sensitivity analyses were also performed to assess the impact of uncertainty. Results For treatment naive patients with Genotype 1, immediate treatment with all-oral regimen under assumed cost and efficacy at present was cost-effective compared with peginterferon α-2a (PegIFN) regimen at present with an ICER of $12536 per QALY gained and a positive NB of $6832 at a willingness-to-pay threshold of $21209. And it was more than 95% likely to be cost-effective if weekly drug cost was less than $1000. Moreover, patients delaying treatment for all-oral regimen in the 1st year were associated with increase in QALYs of 0.62 and increase in cost of $10114 compared with initiating PegIFN regimen at present, which resulted in a positive NB of $3115. Conclusion From a payer perspective, all-oral regimen is associated with good long-term health and economic benefit for treatment-naive patients infected with HCV genotype 1. Particularly, if all-oral regimen would become available at lower price in the future, delaying treatment for all-oral regimen may be a good choice for patients in China.
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Affiliation(s)
- Hai Chen
- Department of Infectious Diseases Control, Wuxi Center for Disease Control and Prevention, Wuxi, Jiangsu, China
- * E-mail:
| | - Lijun Chen
- Department of Infectious Diseases Control, Wuxi Center for Disease Control and Prevention, Wuxi, Jiangsu, China
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25
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Lin S, Ye Q, Wang M, Wu Y, Weng Z, Zhu Y. Antiviral Therapy in Chronic Hepatitis B With Mild Acute Exacerbation. Gastroenterology Res 2017; 10:6-14. [PMID: 28270871 PMCID: PMC5330687 DOI: 10.14740/gr754w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2017] [Indexed: 11/11/2022] Open
Abstract
Background The aim of this study was to assess the efficacy and safety of peginterferon α-2a (pegIFN) and nucleos(t)ide analogues (NA) treatments in patients with hepatitis B envelope antigen (HBeAg)-positive chronic hepatitis B (CHB) with mild acute exacerbation (AE). Methods Treatment-naive HBeAg-positive CHB patients with AE who received pegIFN or NA (entecavir (ETV) or telbivudine (LDT)) therapies were retrospectively selected. The HBeAg seroconversion rate, hepatitis B surface antigen (HBsAg) loss rate and the cost-effectiveness of different treatments were compared. Results A total of 63 patients with pegIFN therapy and 78 with NA (38 with ETV and 40 with LDT) therapy were included. The HBsAg loss rate was significantly higher in the pegIFN group when compared with the NA group (on week 96: 9/63 (14.29%) vs. 1/78 (1.28%), P = 0.005). No significant difference in hepatitis B virus (HBV) DNA negativity or the HBeAg/HBsAg seroconversion rate was found between ETV and LDT group. One year of pegIFN therapy resulted in 18.56 quality-adjusted life years (QALYs) per patient, and the incremental cost per additional QALY gained was $3,709. Conclusions PegIFN therapy is safe in HBeAg-positive CHB patients with mild AE, as it results in a higher HBsAg loss rate and longer QALYs than NA therapy.
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Affiliation(s)
- Su Lin
- Liver Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Qiaoxia Ye
- Liver Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China; Clinical Liver Center of the 180th Hospital of People's Liberation Army, Quanzhou 362100, China
| | - Mingfang Wang
- Liver Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Yinlian Wu
- Liver Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Zhiyuan Weng
- Cardiology Department, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Yueyong Zhu
- Liver Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
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26
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Seto WK, Lau EHY, Wu JTK, Hung IFN, Leung WK, Cheung KS, Fung J, Lai CL, Yuen MF. Effects of nucleoside analogue prescription for hepatitis B on the incidence of liver cancer in Hong Kong: a territory-wide ecological study. Aliment Pharmacol Ther 2017; 45:501-509. [PMID: 27976416 DOI: 10.1111/apt.13895] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 10/27/2016] [Accepted: 11/18/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND The temporal relationship between nucleoside analogue therapy for chronic hepatitis B (CHB) and liver cancer development has not been evaluated at a population level. AIM To investigate the impact of nucleoside analogue prescription on liver cancer incidence in a CHB-prevalent region. METHODS We obtained territory-wide nucleoside analogue prescription data from 1999, when nucleoside analogue was first available in Hong Kong, to 2012 and the population-based liver cancer incidence data from 1990 to 2012. We compared the liver cancer incidences from 1990 to 1998 and 1999 to 2012 with adjustment for local hepatitis B surface antigen seroprevalence. RESULTS Nucleoside analogue prescription patient headcount increased from 2006 per year in 1999 to 26 411 in 2012. Prescription volume in 2012 was highest among 55-64 years (30.3%), higher than 65-74 years (13.0%) and ≥75 years (5.8%). Age-standardised liver cancer incidence 1999-2012 decreased by 1.88%/year (95% CI 3.34% to 0.42%/year). NA therapy was associated with decline in age-adjusted liver cancer incidence (2.7 per 100 000 persons, P < 0.001, 95% CI 1.4-4.0 per 100 000 persons). Fifty-five to sixty-four years age group had the most significant decline (men: 24.0 per 100 000 persons, P = 0.001, 95% CI 11.4-36.6 per 100 000 persons; women: 8.5 per 100 000 persons, P = 0.009, 95% CI 2.3-14.6 per 100 000 persons). No significant association was noted in age groups 65-74 years and ≥75 years (both P > 0.05). CONCLUSIONS Nucleoside analogue prescription was associated with a reduction of overall liver cancer incidence in a CHB-prevalent region. The lack of association among individuals of ≥65 years was consistent with the low nucleoside analogue prescription volume in elderly patients, mitigating the impact of CHB treatment on liver cancer.
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Affiliation(s)
- W-K Seto
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.,State Key Laboratory for Liver Research, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - E H Y Lau
- School of Public Health, The University of Hong Kong, Hong Kong
| | - J T K Wu
- School of Public Health, The University of Hong Kong, Hong Kong
| | - I F N Hung
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - W K Leung
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - K-S Cheung
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - J Fung
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.,State Key Laboratory for Liver Research, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - C-L Lai
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.,State Key Laboratory for Liver Research, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - M-F Yuen
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.,State Key Laboratory for Liver Research, The University of Hong Kong, Queen Mary Hospital, Hong Kong
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27
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Mantovani LG, Cortesi PA, Strazzabosco M. Effective but costly: How to tackle difficult trade-offs in evaluating health improving technologies in liver diseases. Hepatology 2016; 64:1331-42. [PMID: 26926906 DOI: 10.1002/hep.28527] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 02/18/2016] [Accepted: 02/21/2016] [Indexed: 12/11/2022]
Abstract
UNLABELLED In the current context of rising health care costs and decreasing sustainability, it is becoming increasingly common to resort to decision analytical modeling and health economics evaluations. Decision analytic models are analytical tools that help decision makers to select the best choice between alternative health care interventions, taking into consideration the complexity of the disease, the socioeconomic context, and the relevant differences in outcomes. We present a brief overview of the use of decision analytical models in health economic evaluations and their applications in the area of liver diseases. The aim is to provide the reader with the basic elements to evaluate health economic analysis reports and to discuss some limitations of the current approaches, as highlighted by the case of the therapy of chronic hepatitis C. To serve its purpose, health economics evaluations must be able to do justice to medical innovation and the market while protecting patients and society and promoting fair access to treatment and its economic sustainability. CONCLUSION New approaches and methods able to include variables such as prevalence of the disease, budget impact, and sustainability into the cost-effectiveness analysis are needed to reach this goal. (Hepatology 2016;64:1331-1342).
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Affiliation(s)
| | | | - Mario Strazzabosco
- Section of Digestive Diseases, International Center for Digestive Health, Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.,Liver Center & Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
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28
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Goyal A, Murray JM. Cost-Effectiveness of Peg-Interferon, Interferon and Oral Nucleoside Analogues in the Treatment of Chronic Hepatitis B and D Infections in China. Clin Drug Investig 2016; 36:637-48. [DOI: 10.1007/s40261-016-0409-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Toy M, Hutton DW, So SK. Cost-Effectiveness and Cost Thresholds of Generic and Brand Drugs in a National Chronic Hepatitis B Treatment Program in China. PLoS One 2015; 10:e0139876. [PMID: 26536626 PMCID: PMC4633043 DOI: 10.1371/journal.pone.0139876] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 09/02/2015] [Indexed: 12/14/2022] Open
Abstract
Chronic liver disease and liver cancer associated with chronic hepatitis B (CHB) are leading causes of death among adults in China. Although newborn hepatitis B immunization has successfully reduced the prevalence of CHB in children, about 100 million Chinese adults remain chronically infected. If left unmanaged, 15–25% will die from liver cancer or liver cirrhosis. Antiviral treatment is not necessary for all patients with CHB, but when it is indicated, good response to treatment would prevent disease progression and reduce disease mortality and morbidity, and costly complications. The aim of this study is to analyze the cost-effectiveness of generic and brand antiviral drugs for CHB treatment in China, and assessing various thresholds at which a highly potent, low resistance antiviral drug would be cost-saving and/or cost-effective to introduce in a national treatment program. We developed a Markov simulation model of disease progression using effectiveness and cost data from the medical literature. We measured life-time costs, quality adjusted life years (QALYs), incremental cost-effectiveness ratios (ICERs), and clinical outcomes. The no treatment strategy incurred the highest health care costs ($12,932-$25,293) per patient, and the worst health outcomes, compared to the antiviral treatment strategies. Monotherapy with either entecavir or tenofovir yielded the most QALYs (14.10–19.02) for both HBeAg-positive and negative patients, with or without cirrhosis. Threshold analysis showed entercavir or tenofovir treatment would be cost saving if the drug price is $32–75 (195–460 RMB) per month, highly cost-effective at $62–110 (379–670 RMB) per month and cost-effective at $63–120 (384–734 RMB) per month. This study can support policy decisions regarding the implementation of a national health program for chronic hepatitis B treatment in China at the population level.
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Affiliation(s)
- Mehlika Toy
- Asian Liver Center, Department of Surgery, Stanford University School of Medicine, Stanford, CA, 94305, United States of America
- * E-mail:
| | - David W. Hutton
- Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, 48109, United States of America
| | - Samuel K. So
- Asian Liver Center, Department of Surgery, Stanford University School of Medicine, Stanford, CA, 94305, United States of America
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Kushenin Combined with Nucleos(t)ide Analogues for Chronic Hepatitis B: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:529636. [PMID: 26347789 PMCID: PMC4548141 DOI: 10.1155/2015/529636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 06/23/2015] [Accepted: 07/02/2015] [Indexed: 11/17/2022]
Abstract
Objective. To evaluate the efficacy and safety of Kushenin (KS) combined with nucleoside analogues (NAs) for chronic hepatitis B (CHB). Methods. Randomized controlled trials (RCTs) of KS combined with NAs for CHB were identified through 7 databases. Frequencies of loss of serum HBeAg, HBeAg seroconversion, undetectable serum HBV-DNA, ALT normalization, and adverse events at 48 weeks were abstracted by two reviewers. The Cochrane software was performed to assess the risk of bias in the included trials. Data were analyzed with Review Manager 5.3 software. Results. 18 RCTs involving 1684 subjects with CHB were included in the analysis. KS combined with NAs including lamivudine (LAM), entecavir (ETV), adefovir dipivoxil (ADV), and telbivudine (TLV) showed different degree of improvement in CHB indices. KS combined with NAs increased the frequency of loss of serum HBeAg, HBeAg seroconversion, undetectable HBV-DNA levels, and ALT normalization compared with single agents. It also decreased serum ALT and AST level after one-year treatment. However, KS combined with TLV did not show a significant difference in CHB indices. The side-effects of KS combined with NAs were light and of low frequency. Conclusion. KS combined with NAs improves the efficacy of NAs in CHB.
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Chao SD, Wang BM, Chang ET, Ma L, So SK. Medical training fails to prepare providers to care for patients with chronic hepatitis B infection. World J Gastroenterol 2015; 21:6914-6923. [PMID: 26078568 PMCID: PMC4462732 DOI: 10.3748/wjg.v21.i22.6914] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 05/05/2015] [Accepted: 05/27/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate physicians’ knowledge including chronic hepatitis B (CHB) diagnosis, screening, and management in various stages of their training.
METHODS: A voluntary 20-question survey was administered in Santa Clara County, CA where Asian and Pacific Islanders (API) account for a third of the population. Among the 219 physician participants, there were 63 interns, 60 second-year residents, 26 chief residents and 70 attending physicians. The survey asked questions regarding respondents’ demographics, general hepatitis B virus knowledge questions (i.e., transmission, prevalence, diagnostic testing, prevention, and treatment options), as well as, self-reported practice behavior and confidence in knowledge.
RESULTS: Knowledge about screening and managing patients with CHB was poor: only 24% identified the correct tests to screen for CHB, 13% knew the next steps for patients testing positive for CHB, 18% knew the high prevalence rate among API, and 31% knew how to screen for liver cancer. Wald chi-square analysis determined the effect of training level on knowledge; in all cases except for knowledge of liver cancer screening (P = 0.0032), knowledge did not significantly increase with length in residency training or completion of residency.
CONCLUSION: Even in a high-risk region, both medical school and residency training have not adequately prepared physicians in the screening and management of CHB.
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MESH Headings
- Adult
- Asian
- California/epidemiology
- Clinical Competence
- Education, Medical, Graduate/methods
- Education, Medical, Undergraduate/methods
- Female
- Health Care Surveys
- Health Knowledge, Attitudes, Practice
- Hepatitis B, Chronic/diagnosis
- Hepatitis B, Chronic/epidemiology
- Hepatitis B, Chronic/therapy
- Humans
- Internship and Residency
- Male
- Medical Staff, Hospital/education
- Native Hawaiian or Other Pacific Islander
- Predictive Value of Tests
- Retrospective Studies
- Specialization
- Surveys and Questionnaires
- Treatment Outcome
- Young Adult
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CHANG MS, TUOMALA R, RUTHERFORD AE, MUTINGA ML, ANDERSSON KL, BURMAN BE, BROWN RS, OKEN E, UKOMADU C. Postpartum care for mothers diagnosed with hepatitis B during pregnancy. Am J Obstet Gynecol 2015; 212:365.e1-7. [PMID: 25281364 PMCID: PMC4346392 DOI: 10.1016/j.ajog.2014.09.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 09/01/2014] [Accepted: 09/26/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVE We sought to determine rates of maternal postpartum hepatitis B virus (HBV) follow-up with a HBV specialist and identify factors associated with poor follow-up, as prior research has focused on infant outcomes and not maternal care. STUDY DESIGN We conducted a retrospective review of data from Partners HealthCare system, the largest health care system in Massachusetts, and identified women with chronic HBV who delivered from 2002 through 2012. RESULTS We identified 291 women (mean age 31.5 years, 51% Asian) with incident HBV during pregnancy. In all, 47% had postpartum follow-up with a HBV specialist, but only 19% also had appropriate laboratory tests (hepatitis B e antigen [HBeAg], hepatitis B e antibody, HBV DNA, and ALT) within 1 year of their HBV diagnosis. Mothers with HBV follow-up were more likely to have a primary care physician (PCP) within the Partners HealthCare system (66% vs 38%, P < .0001), a positive HBeAg (20% vs 8%, P = .004), and elevated AST values (17% vs 8%, P = .02). On multivariable logistic regression analysis, a mother who had a PCP (odds ratio, 2.50; 95% confidence interval, 1.37-4.59) or positive HBeAg (odds ratio, 4.45; 95% confidence interval, 1.64-12.06) had a greater likelihood of having HBV follow-up. CONCLUSION Only 19% of HBV-infected mothers met care guidelines 1 year after being diagnosed with HBV. Inadequate postpartum HBV care affects women of all races/ethnicities. Women who had a PCP as well as those who were HBeAg positive were more likely to be referred for postpartum follow-up with a HBV specialist, suggesting that providers might be referring patients when they perceive HBV to be more serious or complex.
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Affiliation(s)
- Matthew S. CHANG
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Ruth TUOMALA
- Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Anna E. RUTHERFORD
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Muthoka L. MUTINGA
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Karin L. ANDERSSON
- Division of Gastroenterology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Blaire E. BURMAN
- Division of Gastroenterology, University of California, San Francisco, 513 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Robert S. BROWN
- Center for Liver Disease and Transplantation, Columbia University College of Physicians and Surgeons, 622 West 168th Street, PH 14-105, New York, NY 10032, USA
| | - Emily OKEN
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 6th Floor, Boston, MA 02215, USA
| | - Chinweike UKOMADU
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA
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Mendoza RL. Can healthcare solutions form part of the problem? Senegal's dichotomized approach to hepatitis B prevention. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2014. [DOI: 10.1179/2047971914y.0000000095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Younossi Z, Henry L. Monitoring and treatment of inactive chronic hepatitis B: is it cost-effective? Hepatology 2014; 60:19-21. [PMID: 24504789 DOI: 10.1002/hep.27062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 02/04/2014] [Indexed: 12/07/2022]
Affiliation(s)
- Zobair Younossi
- Department of Medicine, Inova Fairfax Hospital, Falls Church, VA; Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA
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Toy M, Demirci U, So S. Preventing hepatocellular carcinoma: the crucial role of chronic hepatitis B monitoring and antiviral treatment. Hepat Oncol 2014; 1:255-257. [PMID: 30190959 DOI: 10.2217/hep.14.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Mehlika Toy
- Asian Liver Center, Department of Surgery, Stanford School of Medicine, Stanford, CA 94305, USA.,Asian Liver Center, Department of Surgery, Stanford School of Medicine, Stanford, CA 94305, USA
| | - Utkan Demirci
- Canary Center for Early Detection of Cancer, Radiology, Stanford School of Medicine, Stanford, CA 94305, USA.,Canary Center for Early Detection of Cancer, Radiology, Stanford School of Medicine, Stanford, CA 94305, USA
| | - Samuel So
- Asian Liver Center, Department of Surgery, Stanford School of Medicine, Stanford, CA 94305, USA.,Asian Liver Center, Department of Surgery, Stanford School of Medicine, Stanford, CA 94305, USA
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