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Health Affairs Deaths And Be Cost-Effective A Simulation Shows That Early Treatment Of Chronic Hepatitis B Infection Can Cut

Chronic hepatitis B affects between 800,000 and two million people in the United States and causes 4,000 deaths each year. Yet the costs and benefits of treatment have not been fully evaluated. Using a model that simulates disease progression, we compare treatment programs for hepatitis B that start at an early stage of the disease to treatment that begins at a late stage. Our analysis concludes that early hepatitis B care can improve health, reduce premature deaths, and prevent expensive complications, making it highly cost-effective in the long term. Our results demonstrate the importance of screening for hepatitis B among at-risk groups and then linking screening to treatment. They also illustrate how predictive models can be used to evaluate strategies for improving access to care. C hronic hepatitis B is amajor cause of cirrhosis of the liver and of “primary” liver cancer, or cancer in which the liver is the primary tumor site. At any given time, the virus affects between 800,000 and twomillion people in the United States. Infection is concentrated among people born in Asia, sub-Saharan Africa, Eastern Europe, South America, and the Caribbean. This disparity is particularly severe in Asian populations within the United States, among whom the infection rate is estimated to be 10–15 percent, compared to the general population infection rate of less than 0.5 percent. Although universal infant vaccination has reduced the number of new infections that occur in the United States, the number of cases of chronic hepatitis B has increased in recent years as a result of immigration from countries where the virus is endemic. Hepatitis B And Public Health Chronichepatitis B infectionhas a long latent, or clinically silent, phase, during which it causes few or no symptoms. It is frequently undiagnosed until symptoms of late-stage complications develop, many years after infection. An estimated 15–40 percent of infected people will eventually develop complications, the most common and deadliest of which are primary liver cancer (hepatocellular carcinoma) and end-stage liver disease. When these complications are diagnosed, they require very expensive treatments and are most often fatal. Hepatitis B infection is responsible for 4,000USdeaths each year. The total direct and indirect annual cost burden of the disease in the United States is estimated to be as high as $1 billion. Hepatitis B infection thus represents a serious public health issue. It remains so despite the fact that new treatments have become available that reduce the amount of virus in the blood (“viral load”)more effectively, canbeadministered for a longer period without the development of resistance, and could avert serious outcomes. In current clinical practice guidelines, viral load is used as a predictor of health outcome, a criterion for starting antiviral treatment, and a marker of treatment effectiveness. The risk for cirrhosis and primary liver cancer increases significantly as viral load levels increase. Therefore, mondoi: 10.1377/hlthaff.2008.0905