Shared-care models are highly effective and cost-effective for managing chronic hepatitis B in China: reinterpreting the primary care and specialty divide

作者全名："Zhang, Lei; Liu, Hanting; Zou, Zhuoru; Su, Shu; Ong, Jason J.; Ji, Fanpu; Cui, Fuqiang; Chan, Po -lin; Ning, Qin; Li, Rui; Shen, Mingwang; Fairley, Christopher K.; Liu, Lan; Seto, Wai-Kay; Wong, William C. W."

作者地址："[Zhang, Lei; Liu, Hanting; Zou, Zhuoru; Ong, Jason J.; Li, Rui; Shen, Mingwang] Xi An Jiao Tong Univ, Hlth Sci Ctr, China Australia Joint Res Ctr Infect Dis, Sch Publ Hlth, Xian, Peoples R China; [Zhang, Lei; Ong, Jason J.; Fairley, Christopher K.] Monash Univ, Fac Med, Cent Clin Sch, Melbourne, Vic, Australia; [Zhang, Lei; Fairley, Christopher K.] Alfred Hlth, Melbourne Sexual Hlth Ctr, Artificial Intelligence & Modelling Epidemiol Prog, Melbourne, Vic, Australia; [Su, Shu] Chongqing Med Univ, Clin Res Management Off, Affiliated Hosp 2, Chongqing, Peoples R China; [Ji, Fanpu] Xi An Jiao Tong Univ, Dept Infect Dis, Affiliated Hosp 2, Xian, Peoples R China; [Cui, Fuqiang] Peking Univ, Sch Publ Hlth, 38 Xueyuan Rd, Beijing, Peoples R China; [Chan, Po -lin] World Hlth Org Western Pacific Reg Off, Div Communicable Dis, Manila, Philippines; [Ning, Qin] Huazhong Univ Sci & Technol, Tongji Hosp, Tongji Med Coll, Dept & Inst Infect Dis, Wuhan, Peoples R China; [Shen, Mingwang] Key Lab Dis Prevent & Control & Hlth Promot Shaanx, Xian, Shaanxi, Peoples R China; [Liu, Lan] Chinese Med Assoc Publishing House, 69 Dongheyanjie St, Beijing, Peoples R China; [Seto, Wai-Kay] Univ Hong Kong, Shenzhen Hosp, Dept Med, Shenzhen, Peoples R China; [Seto, Wai-Kay] Univ Hong Kong, Sch Clin Med, Dept Med, Hong Kong, Peoples R China; [Wong, William C. W.] Univ Hong Kong, State Key Lab Liver Res, Hong Kong, Peoples R China; [Wong, William C. W.] Univ Hong Kong, Shenzhen Hosp, Dept Family Med & Primary Care, Shenzhen, Peoples R China; [Wong, William C. W.] Univ Hong Kong, Li Ka Shing Fac Med, Sch Clin Med, Dept Family Med & Primary Care, Hong Kong, Peoples R China"

通信作者："Seto, WK (通讯作者)，Univ Hong Kong, Shenzhen Hosp, Dept Med, Shenzhen, Peoples R China.; Wong, WCW (通讯作者)，Univ Hong Kong, Shenzhen Hosp, Dept Family Med & Primary Care, Shenzhen, Peoples R China."

来源：LANCET REGIONAL HEALTH-WESTERN PACIFIC

ESI学科分类：　

WOS号：WOS:001029137100001

JCR分区：Q1

影响因子：7.6

年份：2023

卷号：35

期号：　

开始页：　

结束页：　

文献类型：Article

关键词：WHO; Hepatitis; Liver; Cirrhosis; Hepatocellular carcinoma; Health service

摘要："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 & GE;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."

基金机构：National Natural Science Foundation of China

基金资助正文：& nbsp;National Natural Science Foundation of China.