James RG Butler, Rosemary J Korda, Katrina JR Watson, and D Ashley R Watson
The hepatitis B virus (HBV) is a blood-borne and sexually-transmitted virus. Worldwide, approximately 350–400 million people have chronic hepatitis B infection, with prevalence estimates ranging from below 2% in low- endemic countries, to greater than 8% in highly-endemic countries. In Australia, between 0.5 and 2.0% of the population are chronically infected, approximately half of whom are immigrants born in high-endemic countries.
The majority of people with chronic hepatitis B infection, defined as hepatitis B infection lasting 6 months or more, have inactive disease. Around one-fifth to one-quarter has active disease, i.e., chronic hepatitis B. These individuals are particularly at risk of developing life-threatening complications including cirrhosis and liver cancer. Most of the burden of disease and the associated economic costs are associated with these serious sequelae. Around seven thousand disability adjusted life years (DALYs) are lost each year due to hepatitis B in Australia, most of which is due to premature death.
There are three main strategies for dealing with HBV infection in a population – screening, vaccination and treatment. There are currently no screening programs for hepatitis B in Australia. An infant HBV vaccination and adolescent catch-up
program has been in place for over a decade. HBV drug therapy, used to suppress viral replication and liver disease progression, is currently only received by a small proportion of those eligible for treatment. In addition, a small number of liver transplants are performed each year in those with advanced liver disease.
Although Australia has adopted universal hepatitis B vaccination for infants, there are many people already infected for whom vaccination offers no benefit. This, coupled with immigration patterns, the fact that the infected pool of individuals is now ageing and that only a small number of people receive HBV drug therapy, means the long-term sequelae of HBV infection can be expected to become increasingly evident over the forecast period.
This report provides a comprehensive review of the epidemiology and economics of HBV infection in Australia, and projects the mortality, morbidity and direct economic costs likely to arise from HBV infection over the next decade. It also investigates the cost-effectiveness of increasing the number of people who receive drug therapy for chronic hepatitis B, and considers the economic justification for investing in a national strategy for hepatitis B.
Markov mathematical simulations are used to model the current and projected burden of chronic hepatitis B infection in Australia from 2008 to 2017. Three scenarios are considered:
For each of these scenarios, projections are made on the mortality and morbidity associated with hepatitis B and the direct health costs, using data largely derived from published sources.
According to the report, under current levels of medical management and treatment:
In 2017, there will be three times as many cases of HBV-related liver cancer than in 2008, and a marked increase in the number of
deaths attributable to HBV, under current treatment patterns. Concomitantly, increasingly heavy demands on liver clinics nationwide can be expected. While the costs of managing and treating HBV infection can therefore also be expected to increase, this report argues that this investment is economically justified, given the cost-effectiveness of drug therapy for chronic hepatitis B.
The results presented in this report underscore the importance of the National Hepatitis B Strategy currently being developed for Australia, and suggest that the development of this Strategy should be regarded as matter of priority.
Download full paper:
ACERH_RR7 (2.15 MB PDF)
NOhep is a global, grassroots movement aimed at bringing all stakeholders together to eliminate viral hepatitis by 2030. It has been developed to create global awareness of the disease, similar to the red ribbon for HIV/AIDS, and was launched in 2016. NOhep firmly positions itself at the forefront of the elimination conversation, showcasing exemplary leadership, fostering on-the-ground innovative solutions and taking action to support the policy changes needed to eliminate this cancer-causing illness by 2030. Being a part of NOhep means being part of the solution. (To find out more about the development of this exciting initiative, watch this short video: https://youtu.be/Oer-rGwnKZU )