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Cost of treating chronic hepatitis B: Comparison of current treatment guidelines

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AIM:To compare program costs of chronic hepatitis B (CHB) screening and treatment using Australian and other published CHB treatment guidelines.METHODS:Economic modeling demonstrated that in Australia a strategy of hepatocellular cancer (HCC)prevention in patients with CHB is more cost-effective than current standard care,or HCC screening.Based upon this model,we developed the B positive program to optimize CHB management of Australians born in countries of high CHB prevalence.We estimated CHB program costs using the B positive program algorithm and compared them to estimated costs of using the CHB treatment guidelines published by the AsianPacific,American and European Associations for the Study of Liver Disease (APASL,AASLD,EASL) and those suggested by an independent United States hepatology panel.We used a Markov model that factored in the costs of CHB screening and treatment,individualized by viral load and alanine aminotransferase levels,and calculated the relative costs of program components.Costs were discounted by 5％ and calculated in Australian dollars (AUD).RESULTS:Using the B positive algorithm,total program costs amount to 13 979 224 AUD,or 9634 AUD per patient.The least costly strategy is based upon using the AASLD guidelines,which would cost 34％ less than our B positive algorithm.Using the EASL and the United States Expert Group guidelines would increase program costs by 46％.The largest expenditure relates to the cost of drug treatment (66.9％ of total program costs).The contribution of CHB surveillance (20.2％)and HCC screening and surveillance (6.6％) is small -and together they represent only approximately a quarter of the total program costs.CONCLUSION:The significant cost variations in CHB screening and treatment using different guidelines are relevant for clinicians and policy makers involved in designing population-based disease control programs.(C) 2012 Baishideng.All rights reserved.

Chronic hepatitis BMarkov modelHepatocellular cancerTreatment guidelines

Monica Robotin、Yumi Patton、Melanie Kansil、Andrew Penman、Jacob George

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Medical and Scientific Issues Unit, Cancer Council NSW, 153 Dowling St, Wooloomooloo, Sydney 2011, Australia

School of Public Health, University of Sydney, Sydney 2006, Australia

Cathedral Street Partners, 1/96 Cathedral St,Woollomooloo, Sydney 2011, Australia

Faculty of Medicine, University of Sydney,Sydney 2006, Australia

Storr Liver Unit, Westmead Millennium Institute Westmead Hospital, Sydney 2145, Australia

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2012

10.3748/wjg.v18.i42.6106

世界胃肠病学杂志(英文版)
太原消化病研治中心

世界胃肠病学杂志(英文版)

SCI
影响因子：1.001
ISSN：1007-9327
年,卷(期)：2012.18(42)
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