A National Strategy for the Elimination of Hepatitis B and C: Phase Two Report

To study the population health impact and cost-effectiveness of increasing chronic hepatitis B (CHB) diagnosis, care, and antiviral treatment on risks of hepatocellular carcinoma, cirrhosis, and hepatitis B virus (HBV)-related deaths, a Markov model was constructed with disease progression estimates, liver transplantation, and background mortality rates. Age-specific HBsAg prevalence was estimated by race, ethnicity, and nativity, and a 2015 study cohort was constructed from age-group prevalence of HBsAg, HBeAg, chronic active hepatitis, and cirrhosis. Among the estimated 1.29 million people (confidence interval [CI]: 855,000 to 2.02 million) or 0.4 percent of the population living with CHB in the United States in 2015, an estimated 25.8 percent or 333,978 would be eligible for antiviral treatment because they either have chronic active hepatitis or cirrhosis. The scenarios analyzed included Base 2015 current practice with diagnosis, care, and treatment rates at 34.6, 33.3, and 45 percent; Department of Health and Human Services (HHS) 2020 target increasing diagnosis to 66 percent; HHS 2020 target with increased care and treatment at 80 percent; hypothetical 80/80/80 scenario; World Health Organization (WHO) 2030 target at 90/90/80; and idealistic 100/100/100 scenario. If the current diagnosis, care, and treatment cascade remains unchanged, as many as 6 percent of the cohort would develop hepatocellular carcinoma, 10.3 percent cirrhosis, and 9.4 percent would die from HBV-related death by 2030. Compared to current practice, the HHS 2020 diagnosis target would only reduce death by 4.5 percent if care and treatment are not increased.