个人监测慢性乙肝是符合成本效益的战略，对于中国

StephenW

Monitoring individuals with chronic HBV is cost-effective strategy for China
Published on January 16, 2014 at 8:41 AM



A novel study determined that monitoring inactive chronic hepatitis B (HBV) carriers is a cost-effective strategy for China. However, results published in Hepatology, a journal of the American Association for the Study of Liver Diseases, show that increasing treatment, monitoring and adherence to therapy are necessary to achieve significant health benefits at the population level.

The World Health Organization (WHO) estimates that roughly 2 billion individuals worldwide have been infected with HBV—a virus causing acute or chronic liver disease that may lead to cirrhosis or liver cancer (hepatocellular carcinoma, HCC). WHO reports that 240 million are living with chronic HBV, with 1.4 million of those individuals in the U.S. according to estimates from the Centers for Disease Control and Prevention (CDC).

Previous research shows that 60% of the population in China has been infected with HBV and up to 10% are chronically infected, placing them at risk for life-threatening liver disease. In fact, medical evidence estimates that 500,000 Chinese die each year from HBV-related causes.

"China has the largest concentration of people infected with chronic HBV and understanding the health and economic impact is extremely important," explains Dr. Mehlika Toy from the Asian Liver Center at Stanford University School of Medicine who spearheaded the study while she was a Takemi Fellow at the Harvard School of Public Health in Boston, Massachusetts. "Our study is the first to analyze cost and cost-effectiveness of monitoring inactive CHB patients in Shanghai."

Using simulation models, the research team compared the current strategy of not monitoring inactive chronic HBV patients to a monitor and treat (M&T) strategy. The M&T strategy would include twice-yearly assessment of HBV and alanine transaminase (ALT) levels in patients with chronic HBV. For active HBV cases the researchers suggest treatment with entecavir, which evidence shows to be a cost-effective antiviral therapy in China.

Results show that there were 1.5 million adult carriers of HBV in Shanghai, with 63% of those hepatitis B virus e antigen (HBeAg) positive. The number of active cases of chronic HBV, were 258,139 HBeAg-positive group and 152,384 in the HBeAg-negative group. Researchers estimated that the M&T strategy would cost $20,730 (U.S.) and result in 15.45 quality-adjusted life-years (QALYs) per patient, compared to $20,455 and 15.35 QALYs for the current practice.

"Our findings suggest that monitoring of chronic HBV patients is cost-effective, but relies on identifying more cases of HBV infection, and increasing treatment, monitoring, and antiviral adherence to achieve health gains," concludes Dr. Toy. "We estimate that with adherence to monitoring and treatment, HCC could be reduced by 70% and mortality caused by chronic HBV by 83%."

Source: Harvard School of Public Health

StephenW

个人监测慢性乙肝是符合成本效益的战略，对于中国
发表于2014年1月16日在上午08:41 ·

   
一种新的研究确定，监测无效的慢性乙型肝炎（ HBV）携带者是具有成本效益的战略，对于中国。然而，发表在肝脏病学，肝脏病的研究的美国关联日记帐结果，表明越来越多的治疗，监测和坚持治疗是必要的，以实现在群体水平上显著的健康益处。

世界卫生组织（ WHO）估计，全球大约200十亿人曾经感染过乙肝病毒引起的急性或慢性肝脏疾病，可能会导致肝硬化或肝癌（肝细胞癌， HCC） 。世卫组织报告， 2.4亿顷患有慢性乙肝，与这些人在美国140万根据从中心估计疾病控制和预防中心（CDC） 。

以前的研究表明，在中国人口的60 ％已经感染了乙肝病毒和高达10 ％的慢性感染，将它们放置在危险中为威胁生命的肝脏疾病。事实上，医学证据估计有50万中国每年死于乙肝相关的原因。

“中国有人感染慢性乙肝病毒最集中和理解健康和经济的影响是极其重要的，”解释Mehlika玩具博士从亚洲肝脏中心在斯坦福大学医学院谁带头研究，而她是一个武见敬三院士在公共卫生哈佛学校在波士顿，马萨诸塞。 “我们的研究是第一次成本分析和监控无效的慢性乙型肝炎患者在上海的成本效益。 ”

利用仿真模型，研究小组比较不监视无效的慢性乙肝患者的监测和治疗（ M＆T ）战略的现行战略。在M ＆T的战略将包括乙肝病毒的每年两次的评估和丙氨酸转氨酶（ ALT）在慢性HBV水平。对于活动性HBV情况下，研究人员建议治疗恩替卡韦，有证据表明是一个成本有效的抗病毒治疗在中国。

结果表明，有乙肝病毒150万成年人运营商在上海，这些乙肝病毒e抗原（HBeAg ）阳性63 ％ 。慢性乙型肝炎处理的个案数目，分别为258139 HBeAg阳性组和152,384在HBeAg阴性组。研究人员估计， M＆T战略将花费20730美元（美国） ，导致15.45质量调整每名患者的生命年（QALYs ） ，相比20455美元和15.35的QALY的现行做法。

“我们的研究结果表明，监测慢性乙型肝炎患者的成本效益，但依赖于识别HBV感染更多的情况下，增加治疗，监测和抗病毒药物依从性，实现健康收益”的结论玩具博士。 “我们估计，与坚持监测和治疗，肝癌可能是由于70％，引起的慢性乙肝83％的死亡率降低了。 ”

资料来源：哈佛大学公共卫生学院