Toy Mehlika, Hutton David, Conners Erin E, Pham Hang, Salomon Joshua A, So Samuel
Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands.
Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan, United States of America.
PLoS One. 2025 Jan 22;20(1):e0313898. doi: 10.1371/journal.pone.0313898. eCollection 2025.
Patients with chronic hepatitis B infection (CHB) have an increased risk for death from liver cirrhosis and hepatocellular carcinoma (HCC). In the United States, only an estimated 37% of adults with chronic hepatitis B diagnosis without cirrhosis receive monitoring with at least an annual alanine transaminase (ALT) and hepatitis B deoxyribonucleic acid (DNA), and an estimated 59% receive antiviral treatment when they develop active hepatitis or cirrhosis. A Markov model was used to calculate the costs, health impact and cost-effectiveness of increased monitoring of adults with HBeAg negative inactive or HBeAg positive immune tolerant CHB who have no cirrhosis or significant fibrosis and are not recommended by the current American Association for the Study of Liver Diseases (AASLD) clinical practice guidelines to receive antiviral treatment, and to assess whether the addition of HCC surveillance would be cost-effective. For every 100,000 adults with CHB who were initially not recommended for treatment, if the monitoring rate increased from the current 37% to 90% and treatment rate increased from 59% to 80%, 4,600 cases of cirrhosis, 2,450 cases of HCC and 4,700 HBV-related deaths would be averted with a gain of 45,000 QALYs and a savings of $180 million in lifetime health care costs. At a willingness to pay threshold of $100,000/QALY, the addition of HCC surveillance with the standard recommended biannual liver ultrasound and alfa fetoprotein levels is likely cost-effective if the HCC risk ≥ 0.55%/year. Regular monitoring of persons with inactive or immune tolerant CHB who are initially not recommended to receive antiviral treatment in the United States is cost-saving. The addition of HCC surveillance with biannual US and AFP would be cost-effective for individuals with HCC incidence ≥ 0.55%/year.
慢性乙型肝炎感染（CHB）患者死于肝硬化和肝细胞癌（HCC）的风险增加。在美国，估计只有37%的无肝硬化慢性乙型肝炎诊断成年患者接受至少每年一次的丙氨酸转氨酶（ALT）和乙肝脱氧核糖核酸（DNA）监测，估计59%的患者在出现活动性肝炎或肝硬化时接受抗病毒治疗。采用马尔可夫模型计算增加对无肝硬化或显著纤维化、且目前美国肝病研究协会（AASLD）临床实践指南不建议接受抗病毒治疗的HBeAg阴性非活动性或HBeAg阳性免疫耐受CHB成年患者监测的成本、健康影响和成本效益，并评估增加HCC监测是否具有成本效益。对于每10万名最初不建议治疗的CHB成年患者，如果监测率从目前的37%提高到90%，治疗率从59%提高到80%，将避免4600例肝硬化、2450例HCC和4700例HBV相关死亡，获得45000个质量调整生命年（QALY），并在终身医疗保健成本上节省1.8亿美元。在每QALY支付意愿阈值为10万美元的情况下，如果HCC风险≥0.55%/年，增加标准推荐的每半年一次肝脏超声和甲胎蛋白水平的HCC监测可能具有成本效益。在美国，对最初不建议接受抗病毒治疗的非活动性或免疫耐受CHB患者进行定期监测可节省成本。对于HCC发病率≥0.55%/年的个体，增加每半年一次超声和甲胎蛋白的HCC监测将具有成本效益。
