Shevanthi Nayagam1,2, Polin Chan3, Kun Zhao4, Elisa Sicuri5,6, Xiaochun Wang7, Jidong Jia8, Lai Wei9, Nick Walsh10, Lance E Rodewald3, Guomin Zhang11, Wang Ailing12, Lan Zhang3, Joo H Chang4, WeiWei Hou4, Yingpeng Qiu4, Binyan Sui4, Yue Xiao4, Hui Zhuang13, M R Thursz1, Fabio Scano3, Daniel Low-Beer14, Bernhard Schwartländer14, Yu Wang15, Timothy B Hallett2. 1. Section of Hepatology and Gastroenterology, Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, United Kingdom. 2. MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London,UK. 3. World Health Organization China office, Beijing, China. 4. China National Health Development Research Center, National Health and Family Planning Commission, Beijing, China. 5. Health Economics Group, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom. 6. ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain. 7. National Center for AIDS Control and Prevention (NCAIDS), China Center for Disease Control and Prevention, Beijing, China. 8. Liver Research Center, Beijing Friendship Hospital, Beijing, China. 9. Peking University People's Hospital, Peking University Hepatology Institute, Beijing, China. 10. World Health Organization regional office for the Western Pacific, Manila, Philippines. 11. National Immunization Programme, China Center for Disease Control and Prevention, Beijing, China. 12. National Center for Women and Children's Health, China Center for Disease Control and Prevention, Beijing, China. 13. Department of Microbiology and Infectious Disease Center, Peking University Health Science Center, Beijing, China. 14. World Health Organization, Geneva, Switzerland. 15. China Center for Disease Control and Prevention, Beijing, China.
Abstract
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.
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.
Authors: Bernhard Schwartländer; John Stover; Timothy Hallett; Rifat Atun; Carlos Avila; Eleanor Gouws; Michael Bartos; Peter D Ghys; Marjorie Opuni; David Barr; Ramzi Alsallaq; Lori Bollinger; Marcelo de Freitas; Geoffrey Garnett; Charles Holmes; Ken Legins; Yogan Pillay; Anderson Eduardo Stanciole; Craig McClure; Gottfried Hirnschall; Marie Laga; Nancy Padian Journal: Lancet Date: 2011-06-11 Impact factor: 79.321
Authors: Shu Su; William Cw Wong; Zhuoru Zou; Dan Dan Cheng; Jason J Ong; Polin Chan; Fanpu Ji; Man-Fung Yuen; Guihua Zhuang; Wai-Kay Seto; Lei Zhang Journal: Lancet Glob Health Date: 2022-02 Impact factor: 26.763