Economic analysis of hepatitis B screening and treatment.

نویسنده

  • Vincent Lo Re
چکیده

Approximately 350 million people worldwide are living with chronic hepatitis B virus (HBV) infection, and an estimated 620,000 die annually from complications of HBV-related liver disease [1]. In the United States, the incidence of acute HBV infection has declined substantially since 1985 as a result of the availability of effective HBV vaccines and widespread immunization of infants and high-risk populations [2]. Nevertheless, approximately 43,000 new cases of acute HBV infection occur each year in the United States [3]. Further, although vaccination programs have successfully reduced the incidence, the prevalence of chronic HBV infection has not declined, primarily because of the immigration of chronically infected persons from countries with high or intermediate HBV endemicity [4]. National surveys indicate that approximately 1.25 million US residents have chronic HBV infection (prevalence, 0.3%–0.5%) [5], and many are likely unaware of their infection status [6]. The public health impact of chronic HBV infection is almost entirely related to its long-term effects on liver-related complications [7, 8]. Specifically, chronic HBV infection is a major cause of cirrhosis, hepatic decompensation, and hepatocellular carcinoma, and the risk of these complications increases with higher HBV DNA levels [9, 10]. The number of hospitalizations, outpatient visits, and expenditures associated with chronic HBV infection has persistently increased over the past 20 years [4, 11], and as the influx of patients with chronic HBV infection in the United States continues, utilization of HBV-related health care services is expected to increase further. Given the prevalence of chronic HBV infection and its public health impact, screening the members of at-risk groups for HBV infection with HBV surface antigen (HBsAg) has the potential to identify chronically infected patients before long-term complications manifest. Identification of chronic HBV infection by means of screening enables the implementation of a number of important interventions that could decrease the risk of subsequent liverrelated complications and help to reduce transmission of infection, including (1) counseling to encourage the adoption of behaviors that reduce the risk of HBV transmission; (2) determination of close contacts who require HBsAg testing and subsequent vaccination (if HBsAgnegative); (3) avoidance of excessive alcohol; (4) clinical evaluation to detect hepatic decompensation; (5) screening for viral coinfections (eg, human immunodeficiency virus, hepatitis C, and hepatitis D); 6) periodic surveillance for hepatocellular carcinoma; (7) immunization against hepatitis A; and (8) initiation of antiviral therapy, if warranted, to delay or reverse the progression of liver disease. The Centers for Disease Control and Prevention released comprehensive HBV testing recommendations in 2008 (Table 1) [12]. In particular, these guidelines recommend screening for HBV infection for persons born in regions where the HBV prevalence is >2%, but it has been unclear whether this 2% screening threshold is cost-effective. Very few data have evaluated the cost-effectiveness of screening for active HBV infection. Such economic analyses are important, however, to help clinicians and health policymakers determine whether current HBV screening strategies constitute an effective use of health care resources [13, 14]. In this issue of Clinical Infectious Diseases, Eckman and colleagues address the important and relevant question of the cost-effectiveness of screening for HBV infection with HBsAg in the United States and treating eligible patients [15]. The investigators conducted a cost-effectiveness analysis using a Markov model, a repetitive decision tree that models health outcomes occurring over time [16]. The investigators determined the probabilities associated with transitions to these outcomes and the distributions of Received 25 February 2011; accepted 1 March 2011. Correspondence: Vincent Lo Re III, MD, MSCE, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 836 Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104-6021 (vincentl@mail. med.upenn.edu). Clinical Infectious Diseases 2011;52(11):1307–1309 The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: [email protected]. 1058-4838/2011/5211-0006$14.00 DOI: 10.1093/cid/cir238

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عنوان ژورنال:
  • Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

دوره 52 11  شماره 

صفحات  -

تاریخ انتشار 2011