Journal of Viral Hepatitis

Wei, Na; Liu, Maobai; Cai, Hongfu; Li, Na; Yang, Jing; Huang, Shunmin; Zheng, Bin

doi: 10.1111/jvh.70170pmid: N/A

Chronic hepatitis B (CHB) refers to a global infectious disease caused by the hepatitis B virus. The treatment of CHB causes a heavy economic burden to society. To ensure the rational allocation of medical resources in the whole society and achieve the goal of patients' satisfaction and economy, this study aimed to evaluate the economics of de novo combination of tenofovir alafenamide fumarate (TAF) as the first‐line nucleos(t)ide analogues (NAs) and peginterferon alfa‐2b (PEG‐IFNα‐2b) versus PEG‐IFNα‐2b monotherapy of HBeAg‐positive CHB in China. The Markov model was used to simulate the transition of HBeAg‐positive CHB patients aged 30 in China under various health states using TreeAge Pro 2011 software. The cycle length was 1 year, and the cycle period of the model was 50 years. The model parameters included clinical efficacy, cost, transition probability and discount rate. Cost‐effectiveness analysis was conducted through simulation of the total cost and quality adjusted life years (QALYs) of various treatment options through models. Simultaneously, one‐way sensitivity analysis, probabilistic sensitivity analysis and scenario analysis were performed. De novo combination of TAF and PEG‐IFNα‐2b and PEG‐IFNα‐2b monotherapy resulted in 11.16 and 10.81 QALYs, with total costs of $55559.72 and $57670.23, respectively. De novo combination strategy for HBeAg‐positive CHB patients can save costs and obtain more health outcomes. Sensitivity analyses showed the reliability of the results. From the perspective of the whole society, the de novo combination strategy of TAF and PEG‐IFNα‐2b for patients with HBeAg‐positive CHB may be more cost‐effective than PEG‐IFNα‐2b monotherapy.

Starinieri, Irene; Chitnis, Amit; Wong, Robert J.; Yette, Emily; Pham, Hang; Tang, Amy S.; So, Samuel; Toy, Mehlika

doi: 10.1111/jvh.70176pmid: N/A

Monitoring and retention in care remain suboptimal for patients diagnosed with chronic hepatitis B (CHB) infection with only a minority receiving consistent follow‐up. This study evaluates the cost‐effectiveness of interventions aimed at improving long‐term monitoring and retention in care among diagnosed CHB. A Markov model simulated outcomes for a cohort of 100,000 adults, comparing current practice to three interventions: EHR‐based provider reminders, patient navigators and a combined strategy. Costs and quality‐adjusted life years (QALYs) were evaluated from a healthcare perspective. All interventions were cost‐effective, with weighted incremental cost‐effectiveness ratios (US$/QALY) of US$8069 (EHR reminders), US$8416 (Patient Navigators) and US$8608 (Combined). Compared with current practice, a combined strategy would avert 1670 cases of compensated cirrhosis, 738 cases of decompensated cirrhosis, 1011 cases of hepatocellular carcinoma, 188 liver transplants, and 2058 CHB‐related deaths in a cohort of 100,000. Structured interventions to improve CHB monitoring can deliver substantial health gains at modest costs. These findings can support policy initiatives to improve CHB care retention and highlight the importance of tailoring interventions to local healthcare capacity and population needs.

Hill, Kristi C.; Brinkley, Sherilyn; Latimer, Maria; Tichnell, Patricia; Agee, Tracy; Bittner, Jackie; Thomas, David L.; Sulkowski, Mark S.; Falade‐Nwulia, Oluwaseun

doi: 10.1111/jvh.70173pmid: 41889266

Despite overall decline in hepatitis C virus (HCV) incidence in the United States, incidence in rural areas has continued to increase, primarily driven by injection drug use. Models of HCV care serving people in rural areas are needed. The TRAnsporting Hep C Viral ELimination Services via Telemedicine (TRAVEL) Program was implemented to increase access to HCV care in rural Maryland through an integrated model of local nurse case management support and facilitated telemedicine embedded within a local health department. Between January 2018 and March 2024, 502 anti‐HCV+ patients were referred to the program. Of those referred, 384 [76%] were linked to care, with the majority having a substance use disorder (SUD) diagnosis [236 (61%)]. Laboratory draws and challenges with subsequent phone contact were barriers to initial linkage of referred individuals. Among the 282 patients who completed baseline labs and had HCV viremia, 272 [96%] attended a provider visit, 262 [93%] initiated DAA therapy, 254 [90%] completed treatment, 188 [67%] completed HCV cure labs and 186 [66%] had confirmed HCV cure. There was no significant difference in treatment initiation and completion between patients with and without SUDs, but patients with SUD were significantly less likely to complete HCV cure labs [aOR 0.43 (0.21, 0.82)]. The TRAVEL Program achieved high retention in care and HCV cure rates; however, a quarter of referred patients were not linked to care, and laboratory draws were a barrier along the care continuum. Strategies to optimize linkage and laboratory evaluation are needed.

Lee, So Yoon; Shin, Hyoung Doo

doi: 10.1111/jvh.70175pmid: N/A

Hepatitis B virus (HBV) and hepatocellular carcinoma (HCC) are serious medical problems worldwide. Today, many researchers believe that genetic variations play a major role in how easily someone gets infected and how the disease progresses over time. Although many genetic association studies have suggested various susceptibility loci, lack of consistent results across studies has limited clinical utility. We performed a comprehensive meta‐analysis primarily involving East Asian cohorts. We analysed eight SNPs related to HBV infection and 11 SNPs related to HCC across multiple etiologic subgroups. We found that CD40 rs1883832 and C2 rs9267665 exhibited the strongest associations with susceptibility to HBV infection, with no heterogeneity. We found that HLA‐DPA1 rs3077 and HLA‐DQB1 rs2856718 were significantly associated with HBV infection susceptibility, though with considerable heterogeneity. In our HCC analyses, we found that certain risk variants are linked to specific causes. These include HBV, HCV, alcohol‐related disease, and non‐alcoholic fatty liver disease (NAFLD). Each cause seems to have its own genetic factors. Based on these results, our meta‐analysis brings together many studies to give a clearer picture of the genetic factors that influence HBV infection and HCC in different etiologic pathways. We found that immune‐related genes and HLA class II variants seem to have roles in HBV persistence, while metabolic gene variants are major contributors to HCC risk.

doi: 10.1111/jvh.70174pmid: N/A