Investment Case for a Comprehensive Package of Interventions Against Hepatitis B in China: Applied Modeling to Help National Strategy Planning
Shevanthi Nayagam, Polin Chan, Kun Zhao, Elisa Sicuri, Xiaochun Wang, Jidong Jia, Lai Wei, Nick Walsh, Lance E Rodewald, Guomin Zhang ... Show more
Clinical Infectious Diseases, Volume 72, Issue 5, 1 March 2021, Pages 743–752, https://doi.org/10.1093/cid/ciaa134
Published:
07 April 2020
Article history
In 2016, the first global viral hepatitis elimination targets were endorsed. An estimated one-third of the world’s population of individuals with chronic hepatitis B virus (HBV) infection live in China and liver cancer is the sixth leading cause of mortality, but coverage of first-line antiviral treatment was low. In 2015, China was one of the first countries to initiate a consultative process for a renewed approach to viral hepatitis. We present the investment case for the scale-up of a comprehensive package of HBV interventions.
Methods
A dynamic simulation model of HBV was developed and used to simulate the Chinese HBV epidemic. We evaluated the impact, costs, and return on investment of a comprehensive package of prevention and treatment interventions from a societal perspective, incorporating costs of management of end-stage liver disease and lost productivity costs.
Results
Despite the successes of historical vaccination scale-up since 1992, there will be a projected 60 million people still living with HBV in 2030 and 10 million HBV-related deaths, including 5.7 million HBV-related cancer deaths between 2015 and 2030. This could be reduced by 2.1 million by highly active case-finding and optimal antiviral treatment regimens. The package of interventions is likely to have a positive return on investment to society of US$1.57 per US dollar invested.
Conclusions
Increases in HBV-related deaths for the next few decades pose a major public health threat in China. Active case-finding and access to optimal antiviral treatment are required to mitigate this risk. This investment case approach provides a real-world example of how applied modeling can support national dialog and inform policy planning.
hepatitis B, antiviral treatment, investment case, China, modeling
Topic:
hepatitis b antiviral agents china hepatitis b, chronic investments hepatitis b virus public health medicine viruses case finding prevention