Impact and Cost-Effectiveness of Biomedical Interventions on Adult Hepatitis B Elimination in China: A Mathematical Modelling Study

Abstract

Background: China has one of the highest hepatitis B virus (HBV) disease burdens worldwide and tracking progress toward the 2030 HBV elimination targets is essential. This study aimed to assess the impact of biomedical interventions (i.e., adult vaccination, screening and treatment) on the adult HBV epidemic, estimate the time for HBV elimination, and evaluate the cost-effectiveness of the interventions in China.

Methods: A deterministic compartmental model was developed to project the HBV epidemic from 2022 to 2050 and estimate the time to meet elimination targets under four intervention scenarios. Cost-effectiveness was calculated using incremental cost per quality-adjusted life year (QALY) gained, i.e., average cost-effectiveness ratio (CER).

Results: Under the status quo, there will be 42.09-45.42 million adults living with HBV in 2050 and 11.04-14.36 million HBV-related deaths cumulatively from 2022 to 2050. Universal vaccination would cumulatively avert 3.44-3.95 million new cases at a cost of US$1027-1261/QALY gained. The comprehensive strategy would cumulatively avert 4.67-5.24 million new chronic cases and 1.39-1.85 million deaths, expediting the realization of the elimination targets forward to 2049. This strategy was also cost-effective with an average CER of US$20,796-26,685/QALY and a saved healthcare cost of US$16.10-26.84 per person.

Conclusion: China is not on track to meet the elimination targets but comprehensive biomedical interventions can accelerate the realization of the targets. A comprehensive strategy is cost-effective and cost-saving, which should be promoted in primary care infrastructures. Universal adult vaccination may be appropriate in the near future considering practical feasibility.

Keywords: Cost-effectiveness; Elimination; Hepatitis B; Intervention; Mathematical modeling.

Fig. 1

Epidemic under status quo. a HBsAg prevalence, b Number of people living with HBV, c CHB incidence, and d HBV-related deaths among adults. Shadow area with dotted lines border represent the uncertainty range. HBV hepatitis B virus, CHB chronic hepatitis B

Fig. 2

Impact of four community-based intervention scenarios on a HBsAg prevalence, b number of people living with HBV, c CHB incidence, and d HBV-related deaths among adults. HBV hepatitis B virus, CHB chronic hepatitis B

Fig. 3

Reduction percentage of clinical outcomes of the scenarios compared to the status quo scenario in 2030 (a) and 2050 (b). The black error bar of each bar represents the uncertainty range of the reduction proportion. HBV hepatitis B virus, CC compensated cirrhosis, DC decompensated cirrhosis, HCC hepatocellular carcinoma

Fig. 4

One-way sensitivity analysis of average CER (Comprehensive interventions vs. the Status quo). The dark green of each bar represents the high range of the parameter, and the light green part represents the low range. EV represents the CER for baseline parameters. QALY quality-adjusted life years, IT immune tolerant, IA immune active, IC immune control, IR immune reactivation, CC compensated Cirrhosis, DC decompensated Cirrhosis, HCC hepatocellular carcinoma