Shared Primary-Specialty Care Models for the Management of Chronic Hepatitis B in China: Highly Effective and Cost-effective.

Abstract

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) 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 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 status quo, 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.