First line nucleos(t)ide analog monotherapy is more cost-effective than combination strategies in hepatitis B e antigen-positive chronic hepatitis B patients in China

Background:Nucleos(t)ide analog(NA)in combination with peginterferon(PegIFN)therapy in patients with hepatitis B e antigen(HBeAg)-positive chronic hepatitis B(CHB)shows better effectiveness than NA monotherapy in hepatitis B surface antigen loss,termed"functional cure,"based on previous published studies.However,it is not known which strategy is more cost-effective on functional cure.The aim of this study was to analyze the cost-effectiveness of first-line monotherapies and combination strategies in HBeAg-positive CHB patients in China from a social perspective.Methods:A Markov model was developed with functional cure and other five states including CHB,compensated cirrhosis,decompensated cirrhosis,hepatocellular carcinoma,and death to assess the cost-effectiveness of seven representative treatment strategies.Entecavir(ETV)monotherapy and tenofovir disoproxil fumarate(TDF)monotherapy served as comparators,respectively.Results:In the two base-case analysis,compared with ETV,ETV generated the highest costs with$44,210 and the highest quality-adjusted life-years(QALYs)with 16.78 years.Compared with TDF,treating CHB patients with ETV and NA-PegIFN strategies increased costs by$7639 and$6129,respectively,gaining incremental QALYs by 2.20 years and 1.66 years,respectively.The incremental cost-effectiveness ratios were$3472/QALY and$3692/QALY,respectively,which were less than one-time gross domestic product per capita.One-way sensitivity analysis and probabilistic sensitivity analyses showed the robustness of the results.Conclusion:Among seven treatment strategies,first-line NA monotherapy may be more cost-effective than combination strategies in HBeAg-positive CHB patients in China.

Implementing the communication for development strategy to improve knowledge and coverage of measles vaccination in western Chinese immunization programs:a before-and-after evaluation

Background:Communication for Development(C4D)is a strategy promoted by the United Nations Children’s Fund to foster positive and measurable changes at the individual,family,community,social,and policy levels of society.In western China,C4D activities have previously been conducted as part of province-level immunization programs.In this study,we evaluated the association of C4D with changes in parental knowledge of immunization services,measles disease,and measles vaccine,and changes in their children’s measles vaccine coverage.Methods:From April 2013 to April 2014,C4D activities were implemented as part of provincial immunization programs in the Inner Mongolia,Guangxi,Chongqing,Guizhou,Tibet,Shaanxi,Gansu,Ningxia,and Qinghai provinces.We used a before-and-after study design and employed face-to-face interviews to assess changes in parental knowledge and vaccination coverage.Results:We surveyed 2107 households at baseline and 2070 households after 1 year of C4D activities.Following C4D,95%of caregivers were aware of the vaccination record check requirement for entry into kindergarten and primary school;80%of caregivers were aware that migrant children were eligible for free vaccination;more than 70%of caregivers knew that measles is a respiratory infectious disease;and 90%of caregivers knew the symptoms of measles.Caregivers’willingness to take their children to the clinic for vaccination increased from 51.3%at baseline to 67.4%in the post-C4D survey.Coverage of one-dose measles-containing vaccine(MCV)increased from 83.8%at baseline to 90.1%after C4D.One-dose MCV coverage was greater than 95%in the Guangxi,Shaanxi,and Gansu provinces.Two-dose MCV coverage increased from 68.5 to 77.6%.House-to-house communication was the most popular C4D activity among caregivers(91.6%favoring),followed by posters and educational talks(64.8 and 49.9%favoring).Conclusions:C4D is associated with increased caregiver knowledge about measles,increased willingness to seek immunization services for their children,and increased measles vaccination coverage.Tailored communication strategies based on insights gained from these analyses may be able to increase vaccination coverage in hard-to-reach areas.C4D should be considered for larger scale implementation in China.