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Shared Primary-Specialty Care Models for the Management of Chronic Hepatitis B in China: Highly Effective and Cost-effective
WHO Global health strategies for HIV, hepatitis and STI recommend decentralising routine hepatitis testing and care to primary care. China accounts for one-third of the world's hepatitis B virus (HBV) infections and its national primary care system, capable of providing comprehensive care on ch...
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Published in: | British journal of general practice 2023-07, Vol.73 (suppl 1), p.bjgp23X733881 |
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Main Authors: | , , |
Format: | Article |
Language: | English |
Subjects: | |
Online Access: | Get full text |
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Summary: | WHO Global health strategies for HIV, hepatitis and STI recommend decentralising routine hepatitis testing and care to primary care. China accounts for one-third of the world's hepatitis B virus (HBV) infections and its national primary care system, capable of providing comprehensive care on chronic hepatitis B (CHB), is potentially the answer.
We evaluated the population impacts and cost-effectiveness in three scenarios: (1)
; (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 constructed a decision-tree Markov model to simulate HBV disease progression in a cohort of 100,000 CHB individuals aged ≥18 years over their lifetime. We evaluated from a healthcare provider's perspective with 3% discounting rate and a cost-effectiveness threshold of 3 times China's GDP.
27.97% (89,636 person-years) of the 100,000 CHB individuals would progress to HBV-related complications spending US$569.03m. Compared with
, all shared-care models were cost-effective and cost-saving. Scenario 2 would result in a net gain of 3,015-110,096 quality-adjusted life years (QALYs) preventing 276-8,378 HBV-related deaths. Scenario 3 would result in a net gain of 14,012-117,185 QALYs preventing 1,273-8,874 HBV-related deaths. Improving HBV treatment from currently 11% to 80% would substantially improve its cost-effectiveness, with each dollar relocated to primary care gaining US$2.09 (total US$4.51 billion).
Shared-care CHB models with primary care are highly effective and cost-effective in China. |
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ISSN: | 0960-1643 1478-5242 |
DOI: | 10.3399/bjgp23X733881 |