Roadmap to control HBV and HDV epidemics in China

Area of Science:

• Public Health
• Epidemiology
• Health Economics

Background:

• Hepatitis B virus (HBV) is endemic in China.
• Hepatitis D virus (HDV) coinfection significantly increases mortality risk compared to HBV monoinfection.
• Effective strategies are needed to control both HBV and HDV in China within budget constraints.

Purpose of the Study:

• To devise optimal strategies for controlling HBV and HDV infections in China.
• To allocate an annual budget of $10 billion among various interventions for maximum impact.
• To evaluate the cost-effectiveness of different intervention combinations.

Main Methods:

• Utilized a mathematical model to simulate intervention outcomes.
• Optimally allocated budget across five interventions: testing, adult HBV vaccination, treatment for mono- and dually-infected individuals, second-line HBV treatment, and awareness programs.
• Analyzed projected savings and lives saved over a 10-year period.

Main Results:

• The optimal strategy involves early testing and treatment of both HBV and HDV, coupled with intensive awareness programs.
• This strategy is projected to save an additional 19.8 million HBV infections, 1.9 million HDV infections, and 0.25 million lives over 10 years, with cost savings of $79 billion.
• Incorporating second-line HBV treatment prevents 1.4 million new HBV and 15,000 new HDV infections with minimal additional economic burden.

Conclusions:

• Test and treat programs are highly effective in reducing HBV and HDV prevalence.
• Within the current health budget, China can implement test/treat programs, awareness campaigns, and second-line treatment to minimize disease prevalence and mortality while maximizing economic benefits.