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

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

doi:10.1016/j.lanwpc.2023.100737

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

Lancet Reg Health West Pac. 2023 Mar 20:35:100737. doi: 10.1016/j.lanwpc.2023.100737. eCollection 2023 Jun.

Authors

Lei Zhang^{1

2

3}, Hanting Liu¹, Zhuoru Zou¹, Shu Su⁴, Jason J Ong^{1

2}, Fanpu Ji⁵, Fuqiang Cui⁶, Po-Lin Chan⁷, Qin Ning⁸, Rui Li¹, Mingwang Shen^{1

9}, Christopher K Fairley^{2

3}, Lan Liu¹⁰, Wai-Kay Seto^{11

12}, William C W Wong^{13

14}

Affiliations

¹ China-Australia Joint Research Centre for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China.
² Central Clinical School, Faculty of Medicine, Monash University, Melbourne, VIC, Australia.
³ Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia.
⁴ Clinical Research Management Office, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
⁵ Department of Infectious Diseases, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
⁶ School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, China.
⁷ Division of Communicable Disease, World Health Organization Western Pacific Regional Office, Manila, Philippines.
⁸ Department and Institute of Infectious Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
⁹ Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, Shaanxi, China.
¹⁰ Chinese Medical Association Publishing House, 69 Dongheyanjie Street, XiCheng District, Beijing, China.
¹¹ Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
¹² Department of Medicine, School of Clinical Medicine and State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong, China.
¹³ Department of Family Medicine and Primary Care, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
¹⁴ Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.

Abstract

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 ≥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.

Funding: National Natural Science Foundation of China.

Keywords: Cirrhosis; Health service; Hepatitis; Hepatocellular carcinoma; Liver; WHO.

Grants and funding

001/WHO_/World Health Organization/International