TY - JOUR
T1 - Shared-care models are highly effective and cost-effective for managing chronic hepatitis B in China
T2 - reinterpreting the primary care and specialty divide
AU - Zhang, Lei
AU - Liu, Hanting
AU - Zou, Zhuoru
AU - Su, Shu
AU - Ong, Jason J.
AU - Ji, Fanpu
AU - Cui, Fuqiang
AU - Chan, Po lin
AU - Ning, Qin
AU - Li, Rui
AU - Shen, Mingwang
AU - Fairley, Christopher K.
AU - Liu, Lan
AU - Seto, Wai Kay
AU - Wong, William C.W.
N1 - Funding Information:
LZ is supported by the National Natural Science Foundation of China (Grant number: 81950410639 ); Outstanding Young Scholars Funding (Grant number: 3111500001 ); Xi'an Jiaotong University Basic Research and Profession Grant (Grant number: xtr022019003 and xzy032020032 ); Xi'an Jiaotong University Young Talent Support Grant (Grant number: YX6J004 ), and part of National Key R&D Program of China ( 2022YFC2505100 ). M.S. is supported by National Key R&D Program of China ( 2022YFC2505100 (M.S.)), the National Natural Science Foundation of China ( 12171387 (M.S.)); China Postdoctoral Science Foundation ( 2018M631134 (M.S.), 2020T130095ZX (M.S.)); and Young Talent Support Program of Shaanxi University Association for Science and Technology ( 20210307 (MS)). This study is supported by The University of Hong Kong one-line budget.
Publisher Copyright:
© 2023
PY - 2023/6
Y1 - 2023/6
N2 - 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.
AB - 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.
KW - Cirrhosis
KW - Health service
KW - Hepatitis
KW - Hepatocellular carcinoma
KW - Liver
KW - WHO
UR - http://www.scopus.com/inward/record.url?scp=85149892096&partnerID=8YFLogxK
U2 - 10.1016/j.lanwpc.2023.100737
DO - 10.1016/j.lanwpc.2023.100737
M3 - Article
C2 - 37424676
AN - SCOPUS:85149892096
SN - 2666-6065
VL - 35
JO - The Lancet Regional Health - Western Pacific
JF - The Lancet Regional Health - Western Pacific
M1 - 100737
ER -
