OR models of hepatitis B prove decisive in treating millions in US, China

July 26, 2011, Institute for Operations Research and the Management Sciences

With hepatitis B infecting as many as 10% of people of Asian descent, operations researchers collaborated with a liver transplant surgeon to develop mathematical models that verified the cost effectiveness of hepatitis B interventions. These interventions now successfully screen, treat, and vaccinate millions of Asian and Pacific Islander adults in the U.S. and millions of children in China, according to a paper in a journal of the Institute for Operations Research and the Management Sciences (INFORMS).

Untreated, can become a chronic, lifelong disease that leads to and cirrhosis.

Chinese were considering a program of catch-up vaccinations for children who had not been vaccinated at birth, but were reluctant to commit funds to a widespread hepatitis B catch-up until analysis confirmed its .

The authors' analysis of the program's cost effectiveness influenced the Chinese government's April 2009 decision to expand free catch-up vaccination to all children in China under the age of 15.

They estimate that this decision could result in almost 170 million children being vaccinated and could prevent almost 8 million acute infections, 400,000 , and almost 70,000 deaths. The vaccinations would cost the equivalent of $540 million and save the equivalent of $1.4 billion over the lifetime of these children, for a net present savings of approximately $900 million.

Additionally, they would spare hundreds of thousands of from facing a lifetime of discrimination – those infected with hepatitis B in China, according to reports, are often denied the right to attend school or enter the workplace.

In the U.S., they evaluated four clinical strategies. Of the four, they concluded that it is most cost-effective to adopt a strategy of screening adult Asian and Pacific Islanders for chronic hepatitis B infection so that those identified can receive treatment. They also found it cost-effective to vaccinate those in close contact with the infected so they can be protected from contagion.

Using a common public health metric, they estimate that it costs $36,000–$40,000 per quality-adjusted life year (QALY) gained to screen and provide treatment for adult Asian and Pacific Islanders. In the U.S., an intervention that costs less than $50,000 per QALY gained is generally considered to be cost effective.

The total cost of treating chronically infected people in the U.S. is more than 100 times greater than the cost of the initial screening program. The study provided the convincing evidence that led to the 2010 Institute of Medicine report on Hepatitis and Liver Cancer, as well as the 2011 Health and Human Services' Action Plan to combat the silent epidemic of viral hepatitis and recommend routine screening of foreign born including Asians in the U.S. for chronic hepatitis B infection.

"Doing Good with Good O.R. [Operations Research]: Supporting Cost-Effective Hepatitis B Interventions" is by David W. Hutton and Margaret L. Brandeau of the Department of Management Science and Engineering at Stanford University and Samuel K. So of the Stanford University School of Medicine's Asian Liver Center and Department of Surgery. It appears in a special issue of the INFORMS journal Interfaces that is dedicated to the new, growing field of humanitarian applications in operations research, which applies analytical and mathematical models to benefit the public sector.

"Doing Good with Good O.R." is a program initiated by INFORMS that encourages operations researchers to make major improvements in the public sector using their specialized skills.

With budgets for healthcare chronically tight, the authors evaluated several potential hepatitis B screening, vaccination, and treatment interventions in order to identify the most cost-effective as measured in health benefits per dollar spent.

They used new combinations of decision analysis and Markov models to analyze several interventions.

"Increasingly in medicine, policymakers are looking for evidence of effectiveness and cost-effectiveness to support their decision making," writes Alena Groopman, Global Health Coordinator at the Asian Liver Center. "Typically, conducting clinical trials of HBV [hepatitis B] policies would take decades to gather this evidence. The work that David Hutton, Dr. Margaret Brandeau, and Dr. Sam So have done modeling this disease and these interventions has been incredibly important to accelerating policy changes to improve health related to HBV."

The team was able to achieve their results in approximately a year.

Explore further: Screening for hepatitis B may be cost-effective for more of the population, analysis shows

Related Stories

Screening for hepatitis B may be cost-effective for more of the population, analysis shows

May 3, 2011
Hepatitis B virus (HBV) continues to be a major health issue in the United States despite prevention strategies.

Analysis finds mortality from all causes higher among hepatitis C-infected

June 10, 2011
Although liver-related mortality among those infected with hepatitis C is well-documented, little is known about deaths in these patients that are not related to liver problems. A new study published in Clinical Infectious ...

Recommended for you

Study ends debate over role of steroids in treating septic shock

January 19, 2018
The results from the largest ever study of septic shock could improve treatment for critically ill patients and save health systems worldwide hundreds of millions of dollars each year.

New approach could help curtail hospitalizations due to influenza infection

January 18, 2018
More than 700,000 Americans were hospitalized due to illnesses associated with the seasonal flu during the 2014-15 flu season, according to federal estimates. A radical new approach to vaccine development at UCLA may help ...

Flu may be spread just by breathing, new study shows; coughing and sneezing not required

January 18, 2018
It is easier to spread the influenza virus (flu) than previously thought, according to a new University of Maryland-led study released today. People commonly believe that they can catch the flu by exposure to droplets from ...

Zika virus damages placenta, which may explain malformed babies

January 18, 2018
Though the Zika virus is widely known for a recent outbreak that caused children to be born with microencephaly, or having a small head, and other malformations, scientists have struggled to explain how the virus affects ...

Certain flu virus mutations may compensate for fitness costs of other mutations

January 18, 2018
Seasonal flu viruses continually undergo mutations that help them evade the human immune system, but some of these mutations can reduce a virus's potency. According to new research published in PLOS Pathogens, certain mutations ...

Study reveals how MRSA infection compromises lymphatic function

January 17, 2018
Infections of the skin or other soft tissues with the hard-to-treat MRSA (methicillin-resistant Staphylococcus aureus) bacteria appear to permanently compromise the lymphatic system, which is crucial to immune system function. ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.