Cost-effectiveness of Early Detection of Inactive and Treatment of Active Cases in a High Endemic Chronic Hepatitis B Region
- *Corresponding Author:
- Mehlika Toy
Harvard School of Public Health
Department of Global Health and Population
665 Huntington Avenue, Building #1
Room 1206D, Boston, MA, 02115, USA
E-mail: [email protected]
Received Date: October 27, 2013; Accepted Date: November 22, 2013; Published Date: November 26, 2013
Citation: Li S, Onder FO, Xie Q, Liu Y, Toy M (2013) Cost-effectiveness of Early Detection of Inactive and Treatment of Active Cases in a High Endemic Chronic Hepatitis B Region. J Antivir Antiretrovir 5:154-159. doi: 10.4172/jaa.1000081
Copyright: © 2013 Li S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Background: Persons with chronic hepatitis B (CHB) infection are at risk of developing cirrhosis and hepatocellular carcinoma (HCC). Early detection of active CHB through monitoring and treatment of eligible patients have the potential to prevent these diseases.
Aims: We aimed to predict the disease progression in our baseline patient cohort by using risk prediction tools, and estimate the cost-effectiveness of a monitor and treat (M&T) strategy.
Methods: The REVEAL-HBV study team has developed nomograms for predicting liver cirrhosis and HCC risk in patients with CHB. Baseline data such as gender, birth date, HBVDNA, ALT, HBeAg status, stage of liver disease, genotype, family history of HCC, and alcohol consumption were taken for 668 CHB patients. The cohort was divided into three subgroups according to the eligibility for treatment under the APASL guidelines; ineligible, borderline and eligible, and each were scored according to the REVEAL nomogram tools.
Results: In the ineligible group, if inactive cases are being monitored and treated upon transition to active, the number of new cirrhotic and HCC cases will be reduced by 30% and 40%, respectively. For the borderline group, cirrhosis and HCC will be reduced by 63% and 72%, and for the eligible group, by 84% and 95%, respectively. If we were to implement the M&T strategy, the US$ per QALY gained, compared to do nothing strategy, for sub-groups eligible, borderline, and ineligible are $1,131, $500 and $97, respectively. Conclusions: To reduce the risk of cirrhosis and HCC, a monitor and treat strategy is cost-effective in allsubgroups.