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J Viral Hepat. 2019 Dec 19. doi: 10.1111/jvh.13252. [Epub ahead of print]

Enhancing the hepatitis B care cascade in Australia: A cost-effectiveness model.

Xiao Y1,2,3, Howell J1,2,3,4, van Gemert C1,3, Thompson AJ2,3, Seaman CP1,4, McCulloch K3,5,6,7, Scott N1,4, Hellard ME1,3,4,7,8,9.

Author information

1
Burnet Institute, Melbourne, Vic, Australia.
2
Department of Gastroenterology, St Vicent's Hospital, Melbourne, Vic, Australia.
3
University of Melbourne, Melbourne, Vic, Australia.
4
Monash University, Melbourne, Vic, Australia.
5
WHO Collaborating Centre for Viral Hepatitis, Melbourne, Vic, Australia.
6
Victorian Infectious Diseases Reference Laboratory, Melbourne, Vic, Australia.
7
The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia.
8
School of Population Health, Monash University, Melbourne, Vic, Australia.
9
Department of Infectious Diseases, Alfred Hospital, Melbourne, Vic, Australia.

Abstract

If Australia is to successfully eliminate hepatitis B as a public health threat, it will need to enhance the chronic hepatitis B (CHB) care cascade. This study used a Markov model to assess the impact, cost and cost-effectiveness of scaling up CHB diagnosis, linkage to care and treatment to reach national and international elimination targets for hepatitis B in Australia. Compared to continued current trends, the model calculated the difference in care cascade projection, disability-adjusted life years (DALYs), costs and the incremental cost-effectiveness ratio (ICER), of scaling up CHB diagnosis, linkage to care and treatment to reach: (a) Australia's 2022 national targets and (b) the WHO's 2030 global targets. Achieving the national and WHO targets had ICERs of A$13 435 (A$10 236-A$21 165) and A$14 482 (A$13 031-A$25 641) per DALY averted between 2016 and 2030 in Australia, respectively. However, this excluded implementation and demand generation costs. The ICER for the National Strategy and WHO Strategy remained under A$50 000 per DALY averted if Australia spent up to A$328 or A$538 million, respectively, per annum (for 2016-2030) on implementation and demand generation activities. Sensitivity analysis showed that cost-effectiveness was predominately driven by the cost of CHB treatment and influenced by disease progression rates. Hence for Australia to reach the National Hepatitis B Strategy 2022 targets and WHO Strategy 2030 targets, it requires an improvement in the CHB care cascade. We estimated it is cost-effective to spend up to A$328 million or A$538 million per year to reach the National and WHO Strategy targets, respectively.

KEYWORDS:

care cascade; cost-effectiveness analysis; hepatitis B

PMID:
31856377
DOI:
10.1111/jvh.13252

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