Abstract
Background: Persons with chronic hepatitis B (CHB) infection are at risk of developing cirrhosis and hepatocellular carcinoma (HCC). Early detection of active CHB through monitoring and treatment of eligible patients have the potential to prevent these diseases. Aims: We aimed to predict the disease progression in our baseline patient cohort by using risk prediction tools, and estimate the cost-effectiveness of a monitor and treat (M&T) strategy. Methods: The REVEAL-HBV study team has developed nomograms for predicting liver cirrhosis and HCC risk in patients with CHB. Baseline data such as gender, birth date, HBVDNA, ALT, HBeAg status, stage of liver disease, genotype, family history of HCC, and alcohol consumption were taken for 668 CHB patients. The cohort was divided into three subgroups according to the eligibility for treatment under the APASL guidelines; ineligible, borderline and eligible, and each were scored according to the REVEAL nomogram tools. Results: In the ineligible group, if inactive cases are being monitored and treated upon transition to active, the number of new cirrhotic and HCC cases will be reduced by 30% and 40%, respectively. For the borderline group, cirrhosis and HCC will be reduced by 63% and 72%, and for the eligible group, by 84% and 95%, respectively. If we were to implement the M&T strategy, the US$ per QALY gained, compared to do nothing strategy, for sub-groups eligible, borderline, and ineligible are $1,131, $500 and $97, respectively. Conclusions: To reduce the risk of cirrhosis and HCC, a monitor and treat strategy is cost-effective in allsubgroups.
Highlights
80% of hepatocellular carcinoma (HCC) is due to chronic hepatitis B (CHB) infection [1]
Adults with CHB infection that was acquired through mother-to-infant transmission, which is the case in China, develop HCC at a rate of about 5-10% per decade, which is approximately 100-fold higher than the rate among uninfected persons [2]
Antiviral therapy is the only option to control and prevent progression of disease in patients with active CHB, which is defined as HBV DNA >104 copies/mL, and ALT 2xULN
Summary
80% of hepatocellular carcinoma (HCC) is due to chronic hepatitis B (CHB) infection [1]. Antiviral therapy is the only option to control and prevent progression of disease in patients with active CHB, which is defined as HBV DNA >104 copies/mL, and ALT 2xULN. It is unclear whether patients with mild liver disease, borderline elevated HBV DNA, and mildly elevated ALT levels should be treated at all [3]. Persons with chronic hepatitis B (CHB) infection are at risk of developing cirrhosis and hepatocellular carcinoma (HCC). Detection of active CHB through monitoring and treatment of eligible patients have the potential to prevent these diseases
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