No abstract available.
Chronic Disease ; Hepatitis B, Chronic/economics ; Humans ; Insurance, Health, Reimbursement/*economics ; Korea ; Liver Diseases/*economics ; *Prejudice ; Social Support ; Social Welfare/*economics ; *Societies, Medical ; Socioeconomic Factors

BACKGROUND/AIMS: The purpose of this study was to evaluate the cost-effectiveness of 1 year and up to 5 years of antiviral treatment for chronic hepatitis B (CHB). METHODS: Two ten-health-state Markov models were developed for CHB patients. The proportion of patients remaining alive in each health state, and healthcare costs and quality-adjusted life years (QALYs) were determined during annual cycles of these Markov models. The total healthcare costs, life years, and QALYs over the 40-year time horizon of the model were calculated. The perspectives of the cost-effectiveness analysis were the Korean healthcare system and the healthcare needs of the CHB patient. RESULTS: Short-course therapy with alpha-interferon or 1-year treatment with pegylated interferon alpha-2a, lamivudine (LMV), or adefovir (ADV) had limited impact on disease progression. In contrast, either LMV-ADV or ADV-LMV as rescue medication administered for 5 years resulted in a more sustained decrease in the rate of disease progression. The cost-effectiveness threshold in Korea was estimated to be approximately 25,000,000 South Korean won. LMV administered for 1 year is cost-effective in comparison with no treatment for both HBeAg-positive and HBeAg-negative CHB patients, but longer duration antiviral therapies administered for up to 5 years in CHB patients were found to be highly cost-effective by international standards. CONCLUSIONS: Antiviral treatment of CHB with LMV or ADV for up to 5 years using the alternative antiviral agent as rescue medication appears to be a cost-effective strategy for both HBeAg-positive and HBeAg-negative CHB patients in Korea. Economic evaluation of antiviral therapies should be studied further and updated, particularly for newer agents.
Adenine/*analogs & derivatives/economics/therapeutic use ; Antiviral Agents/*economics/therapeutic use ; Cohort Studies ; Cost-Benefit Analysis ; Drug Therapy, Combination ; Hepatitis B e Antigens/blood ; Hepatitis B, Chronic/drug therapy/*economics ; Humans ; Interferon-alpha/*economics/therapeutic use ; Korea ; Lamivudine/*economics/therapeutic use ; Models, Statistical ; Phosphonic Acids/*economics/therapeutic use ; Quality of Life ; Severity of Illness Index

OBJECTIVETo assess the economic evaluation of short- and long-term antiviral treatments of HBeAg-positive chronic hepatitis B from the perspective of the Chinese health care system.

METHODSA 10-health state Markov model was developed to estimate long-term cost and effectiveness of different treatments of HBeAg-positive CHB. Incremental cost-effectiveness analysis was then carried out.

RESULTSIn comparison with no antiviral treatment, lamivudine administered for 1-year was a highly cost-effective short-course treatment for HBeAg-positive CHB. However, of the treatments evaluated, lamivudine plus adefovir as a rescue medication or adefovir plus lamivudine as a rescue medication administered for 5 years resulted in a more sustained decrease in the rate of disease progression. In comparison with 1 year lamivudine treatment, the incremental cost per Quality Adjusted Life Year (QALY) for treatment with lamivudine plus adefovir or adefovir plus lamivudine as a rescue medication for 5 years was CNY 25 115 and 35 577 respectively, which was 55.2% and 36.5% lower than the estimated international threshold value for China.

CONCLUSIONIn comparison with no antiviral treatment, lamivudine administered for 1-year is a highly cost-effective short-course treatment. Longer duration antiviral treatments, lamivudine plus adefovir or adefovir plus lamivudine as a rescue medication are both cost-effective strategies, resulting in a more sustained decrease in the rate of disease progression.

Adenine ; analogs & derivatives ; economics ; therapeutic use ; Antiviral Agents ; economics ; therapeutic use ; Cost-Benefit Analysis ; economics ; Female ; Hepatitis B e Antigens ; blood ; Hepatitis B, Chronic ; blood ; drug therapy ; economics ; Humans ; Lamivudine ; economics ; therapeutic use ; Male ; Organophosphonates ; economics ; therapeutic use ; Quality-Adjusted Life Years ; Treatment Outcome

BACKGROUND/AIMS: This study analyzed the scale and trends of the social and economic costs of liver disease in Korea for the past 5 years. METHODS: The social aspects of socioeconomic costs were projected for viral hepatitis (B15-B19), liver cirrhosis, malignant neoplasm of the liver (C22) and other liver diseases (K70-K76), as representative diseases by dividing costs into direct and indirect from 2004 to 2008. Direct costs include hospitalization, outpatient, and pharmacy costs in the health-care sector, and transportation and caregiver costs. Indirect costs include the future income loss due to premature death and the loss of productivity resulting from absence from work. RESULTS: The social and economic costs of liver disease were projected to be KRW 5,858 billion in 2004, KRW 5,572 billion in 2005, KRW 8,104 billion in 2006, KRW 6,095 billion in 2007, and KRW 5,689 billion in 2008. The future income loss resulting from premature death is thus greatest, from 73.9% to 86.1%, followed by the direct medical costs, from 9.0% to 18.1%. The productivity loss resulting from absence from work accounts for 3.3-5.5%, followed by the direct nonmedical costs such as transportation and caregiver costs, at 1.5-2.5%. CONCLUSIONS: Among the socioeconomic costs of liver disease in Korea, the future income loss resulting from premature death is showing a decreasing trend, whereas direct medical costs are increasing dramatically.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Cost of Illness ; Female ; Health Care Costs ; Hepatitis/economics ; Humans ; Infant ; Liver Cirrhosis/economics ; Liver Diseases/*economics ; Liver Neoplasms/economics ; Male ; Middle Aged

BACKGROUND: The aim of this study was to report the first experience of using tests of antibody to hepatitis B core antigen (anti-HBc) and antibody to hepatitis B surface antigen (anti-HBs) for the selection of blood donors in a tertiary hospital blood center in Korea. METHODS: From January 2005 to December 2007, the data of all eligible donors according to the Korean Blood Regulation Law were analyzed. Anti-HBc testing was performed in all donors, but anti-HBs was tested only in anti-HBc seropositive donors. Anti-HBs negative but anti-HBc positive donors were regarded as ineligible for blood donation. Cost for donor testing was calculated based on Korean health insurance payment schedule from 2005 to 2007. RESULTS: The seroprevalence of anti-HBc in blood donors was 23.2% (162/699) and increased with increasing age. The proportion of ineligible donors for blood collection was 2.7% (19/699) of total donors and 11.6% (19/162) of anti-HBc seropositive donors. The cost of testing for anti-HBc and anti-HBs was estimated to be about 40% of the total screening cost. CONCLUSIONS: Although additional donor screening tests for anti-HBc and anti-HBs requires increased cost and relatively small number of donors are additionally excluded by these tests, they are considered to be helpful for the safety of blood products, because our blood center has characteristics with small number of donors and relatively high percentage of donors in the age group of thirties and older.
Adolescent ; Adult ; Age Factors ; Blood Banks ; *Blood Donors ; Hepatitis B/diagnosis/economics ; Hepatitis B Antibodies/*blood ; Hepatitis B Core Antigens/*immunology ; Hepatitis B Surface Antigens/*immunology ; Humans ; Korea ; Laboratories, Hospital ; Middle Aged ; Seroepidemiologic Studies ; Serologic Tests/economics

OBJECTIVETo study the cost-effectiveness, benefit and utility of infant hepatitis B vaccination in Shanghai from 1992 to 2001.

METHODSTo calculate the cost of hepatitis B vaccination by cost analysis method. Both the numbers of persons with HBsAg positive and patient with hepatitis B, cirrhosis and liver cancer decreased as the index of direct effect. To study the sick-time and the cost of treating hepatitis B, cirrhosis and liver cancer patients, a face to face questionnaire was used and quasi method was adopted to understand the effect of cure and the course of hepatitis B. The cost benefit analysis method was also used to calculate the cost benefit of HBV vaccine. The disability adjusted life years (DALY) was regarded as an index of utility to measure the disease burden.

RESULTSInput of 501,129.49 Yuan might have the result of reducing one liver cancer patient, ten cirrhosis patients, one hundred chronic hepatitis B patients and one thousand HBsAg positive people. The cost of hepatitis B vaccination was 0.24 hundred million Yuan during the past ten years in Shanghai, which had obtained the total benefit value of 41.22 hundred million Yuan, with a cost benefit ratio of 1:172 Yuan. It was estimated that the total disease burden of hepatitis B, cirrhosis and liver cancer patients was 59,762.55 DALY in order to reduce one DALY loss cost of 402.50 Yuan.

CONCLUSIONHBV vaccine inoculation in infants seemed to be a low-cost input and high-effect output strategy.

Adult ; Cost-Benefit Analysis ; Female ; Hepatitis B ; complications ; economics ; prevention & control ; Hepatitis B Vaccines ; economics ; therapeutic use ; Humans ; Immunization Programs ; economics ; Infant, Newborn ; Liver Cirrhosis ; economics ; etiology ; Liver Neoplasms ; economics ; etiology ; Male ; Markov Chains ; National Health Programs ; Quality of Life ; Surveys and Questionnaires ; Vaccination

OBJECTIVETo evaluate long-term cost effectiveness of telbivudine and lamivudine for the treatment of CHB.

METHODSCost effectiveness was conducted from social health insurance perspective. A Markov model was established based on disease progression pattern and the data from the 2 years GLOBE clinical trial. The information of annual medical expenditure and quality-of-life assessment for different CHB-related diseases was obtained from literature. Incremental cost per life year or quality-adjusted life year gained was measured.

RESULTSCompared with lamivudine, the incremental cost for 1 additional QALY gained with telbivudine in treating HBeAg-positive and -negative CHB were 5403 yuan and 28239 yuan in Beijing, as well 4916 yuan and 29618 yuan in Guangzhou, respectively. According to national economic burden of CHB-related diseases, the ICER with telbivudine vs lamivudine were 1282 yuan and 31565 yuan for HBeAg-positive and -negative CHB.

CONCLUSIONAccording to WHO recommendation for ICER threshold, telbivudine is cost effective in treating HBeAg-positive and -negative CHB, as compared to lamivudine.

Adult ; Antifungal Agents ; economics ; therapeutic use ; China ; epidemiology ; Cost-Benefit Analysis ; DNA, Viral ; blood ; Drug Costs ; statistics & numerical data ; Economics, Pharmaceutical ; Female ; Hepatitis B e Antigens ; blood ; Hepatitis B, Chronic ; complications ; drug therapy ; economics ; epidemiology ; Humans ; Insurance, Long-Term Care ; Lamivudine ; economics ; therapeutic use ; Liver Cirrhosis ; etiology ; prevention & control ; Male ; Markov Chains ; Middle Aged ; Models, Economic ; Nucleosides ; economics ; therapeutic use ; Prescription Drugs ; economics ; Pyrimidinones ; economics ; therapeutic use ; Quality-Adjusted Life Years ; Thymidine ; analogs & derivatives

OBJECTIVETo explore the feasibility of replacement of ordinary syringes by auto-disposal syringes (AD) in China.

METHODSSampling survey was conducted in Hebei province to collect data on the direct medical spending of hepatitis B and their Disability Adjusted Life Year (DALY) losses. The financial burden on hepatitis B was calculated based on the result of field survey as well as through data-base of the Second National Health Services Survey of MOH in 1998. The cost-benefit analysis was employed, in which the saving of the financial burden on hepatitis B patients attributing to unsafe injections was taken as the benefit of intervention and the increased expenditures of AD syringes as the costs.

RESULTSThe total financial disease burden of Hepatitis B in China in 2001 was between RMB 16.19 and 20.17 billion Yuan and the financial disease burden per patient was between RMB 1755.38 and 1409.64 Yuan. Study on the cost-benefit analysis in the replacement intervention program showed high financial feasibility. The Benefit-Cost Ratio (BCR) of the measure was between 32.46 and 97.39, which was bigger in rural areas than that in cities. The direct BCR was less than one when the price gap between ordinary syringe and AD exceeded RMB 0.24 Yuan.

CONCLUSIONThe intervention of safe injection practice through universal usage of AD to replace ordinary syringe seemed to be applicable due to its high potential economic benefits.

China ; epidemiology ; Cost-Benefit Analysis ; Cross Infection ; economics ; etiology ; prevention & control ; Cross-Sectional Studies ; Disposable Equipment ; economics ; statistics & numerical data ; Equipment Reuse ; statistics & numerical data ; Female ; Hepatitis B ; economics ; transmission ; Humans ; Injections ; adverse effects ; economics ; instrumentation ; Male ; Risk Factors ; Sampling Studies ; Surveys and Questionnaires ; Syringes ; economics

Hepatitis A can cause serious illness among adolescents and adults with low vaccination coverage. Even though hepatitis A vaccine is one of the strong candidates for Korean national immunization program, adolescents aged older than 12 yr would not benefit. Our purpose was to assess the willingness and analyze the correlates of Korean mothers for hepatitis A (HepA) vaccination to develop strategies for HepA vaccination. A national telephone survey on 800 mothers with children aged 7-18 yr was conducted with random-digit dialing method. Sixty-two percent and 92% of the mothers reported that they were willing to HepA vaccination at current cost and at half of the current cost, respectively. However, at current cost, only 79% wished to vaccinate their child in an epidemic and 32% wished to vaccinate promptly. Having two or more children, not having future plans to send the child overseas, and low family income were significantly associated with not willing to HepA vaccination. Low perception of the susceptibility for hepatitis A and perception of the current cost as barrier increased the odds of unwillingness to vaccination at current cost and to prompt vaccination. The mothers' willingness to HepA vaccination for the children aged 7-18 yr in Korea was not very high at current cost and associated socioeconomic status and health-belief. Targeted intervention or strategies are needed to increase the HepA vaccination rate among children in Korea.
Adolescent ; Adult ; Child ; Demography ; Female ; Health Status ; Health Surveys ; Hepatitis A/economics/*prevention & control ; Hepatitis A Vaccines/economics/*immunology ; Humans ; Interviews as Topic ; Male ; Middle Aged ; Mothers/psychology ; Republic of Korea ; Social Class ; *Vaccination

Objective: To investigate the economic burden of hepatitis C patients and related factors in Guangdong province. Methods: In this study, cluster sampling method was used to select cases, including acute hepatitis C, chronic hepatitis C and liver cirrhosis cases from eligible outpatients and inpatients in 1 or 2 large general hospitals in all the 21 cities in Guangdong province. Questionnaire survey was conducted for all the hepatitis C patients to analyze their economic burden, while multivariate linear regression model was used to identify the related influencing factors. Results: A total of 356 hepatitis C patients were enrolled in the study, with 176 outpatients (49.4%) and 180 inpatients (50.6%) respectively. The average age of the study subjects was (44.79±11.73) year-olds. The annual direct economic costs of patients with acute hepatitis C, chronic hepatitis C and liver cirrhosis were 10 703.22 (IQR: 7 396.75-16 891.91), 14 886.63 (IQR: 7 274.00-30 228.25) and 28 874.00 (IQR: 13 093.69-56 350.00) Yuan (RMB) respectively. The annual indirect costs appeared as 2 426.99 (IQR: 1 912.18-7 354.52), 3 235.99 (IQR: 1 323.81-6 619.07) and 5 442.35 (IQR: 3 235.99-10 296.33) Yuan (RMB) respectively. The annual intangible costs were 5 000.00 (IQR:2 000.00-10 000.00), 10 000.00 (IQR: 4 000.00-30 000.00) and 10 000.00 (IQR: 3 000.00-100 000.00) Yuan (RMB) respectively. The annual total costs were 22 306.17 (IQR: 14 581.24-50 569.17), 38 050.33 (IQR: 17 449.57-68 319.62) and 80 152.18 (IQR: 40 856.09-228 460.79) Yuan (RMB) respectively. Results from the multiple linear regression analysis showed that factors as: annual hospitalization days, annual number of outpatient visits, annual number of hospitalization, type of disease and the levels of the hospitals were related to the economic burden of patients with hepatitis C. Conclusion: Patients with HCV-related diseases presented serious economic problem which calls for close attention in Guangdong province.
Adult ; China/epidemiology* ; Cities ; Cost of Illness ; Female ; Health Care Costs/statistics & numerical data* ; Hepatitis B/epidemiology* ; Hepatitis C/economics* ; Hospitalization ; Humans ; Liver Cirrhosis/epidemiology* ; Male ; Surveys and Questionnaires