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Investment Case for a Comprehensive Package of Interventions Against Hepatitis B in China: Applied Modeling to Help
Shevanthi Nayagam1,2, Polin Chan3, Kun Zhao4
1Section of Hepatology and Gastroenterology, Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, United Kingdom.
Background:
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.
Insights
Scaling up hepatitis B virus (HBV) interventions in China, including active case-finding and antiviral treatment, can significantly reduce projected deaths and cancer by 2.1 million. This investment offers a positive societal return, demonstrating the value of modeling for policy planning.
Area of Science:
- Hepatology and Viral Hepatitis Research
- Public Health and Epidemiology
- Health Economics and Policy Modeling
Background:
- China faces a significant burden of chronic hepatitis B virus (HBV) infection, with liver cancer being a leading cause of mortality.
- Despite global elimination targets, low antiviral treatment coverage in China necessitates a renewed approach to viral hepatitis management.
- An investment case was developed to support the scale-up of a comprehensive HBV intervention package.
Purpose of the Study:
- To evaluate the impact, costs, and societal return on investment of a comprehensive HBV intervention package in China.
- To model the HBV epidemic in China and assess the effectiveness of scaled-up prevention and treatment strategies.
- To inform national policy and planning through an investment case approach.
Main Methods:
- Development of a dynamic simulation model for the Chinese HBV epidemic.
- Societal perspective analysis incorporating end-stage liver disease management and lost productivity costs.
- Evaluation of a comprehensive package of HBV prevention and treatment interventions.
Main Results:
- Without enhanced interventions, 10 million HBV-related deaths are projected between 2015-2030, including 5.7 million cancer deaths.
- A comprehensive intervention package could reduce these deaths by 2.1 million.
- The intervention package is projected to yield a positive societal return on investment of US$1.57 per US dollar invested.
Conclusions:
- Increased HBV-related deaths present a major public health threat in China for the coming decades.
- Active case-finding and optimal antiviral treatment are crucial to mitigate HBV-related mortality and morbidity.
- Applied modeling provides a valuable tool for national dialogue and policy formulation in viral hepatitis elimination efforts.
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