Hepatitis C virus cure with direct acting antivirals: Clinical,economic, societal and patient value for China

About 10 million people in China are infected with hepatitis C virus(HCV),with the seroprevalence of anti-HCV in the general population estimated at 0.6%.Delaying effective treatment of chronic hepatitis C(CHC)is associated with liver disease progression,cirrhosis,hepatocellular carcinoma,and liver-related mortality.The extrahepatic manifestations of CHC further add to the disease burden of patients.Managing CHC-related advanced liver diseases and systemic manifestations are costly for both the healthcare system and society.Loss of work productivity due to reduced well-being and quality of life in CHC patients further compounds the economic burden of the disease.Traditionally,pegylatedinterferon plus ribavirin(PR)was the standard of care.However,a substantial number of patients are ineligible for PR treatment,and only 40%–75%achieved sustained virologic response.Furthermore,PR is associated with impairment of patient-reported outcomes(PROs),high rates of adverse events,and poor adherence.With the advent of direct acting antivirals(DAAs),the treatment of CHC patients has been revolutionized.DAAs have broader eligible patient populations,higher efficacy,better PRO profiles,fewer adverse events,and better adherence rates,thereby making it possible to cure a large proportion of all CHC patients.This article aims to provide a comprehensive evaluation on the value of effective,curative hepatitis C treatment from the clinical,economic,societal,and patient experience perspectives,with a focus on recent data from China,supplemented with other Asian and international experiences where China data are not available.

One-year direct and indirect costs of ischaemic stroke in China

Background This is the first real-world study to estimate the direct costs and indirect costs of first-ever ischaemic stroke with 1-year follow-up in China,based on a nationally representative sample.Methods Patients were chosen from 20 geographically diverse sites from the nationally representative database China National Stroke Registry-III(CNSR-III).The inclusion criteria were surviving patients who were hospitalised with first-ever ischaemic stroke from February 2017 to February 2018(the index event);aged 18–80 during the index event;no history of other stroke types.The primary endpoints were direct medical costs,direct non-medical costs,indirect costs and total cost(ie,the sum of all cost components).Patient characteristics and clinical data were extracted from CNSR-III.Stroke-related in-hospital direct medical costs were collected from hospital electronic medical records.The patient survey collected data related to out-of-hospital direct medical costs,direct non-medical costs and indirect costs.The secondary objective was to explore clinical factors associated with cost outcomes through univariate analysis and multiple regression.Results The study enrolled 520 patients.The total cost was 57567.48 CNY,with 26612.67 CNY direct medical costs,2787.56 CNY direct non-medical costs and 28167.25 CNY indirect costs.Univariate analysis showed that longer lengths of stay during the index event,higher National Institutes of Health Stroke Scale(NIHSS)and modified Rankin Scale scores were associated with higher costs in all categories.Conversely,EuroQol 5 Dimension utility scores were associated with decreased costs except direct non-medical costs.Multiple regressions showed that higher admission NIHSS scores were independently associated with higher direct medical costs,indirect costs and total cost.Higher 3-month utilities were associated with lower total cost.Conclusion This real-world study showed substantial 1-year economic burden following first-ever ischaemic stroke in China,and that indirect costs are a non-negligible driver of costs.

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.

Criteria air pollutants and hospitalizations of a wide spectrum of cardiovascular diseases: A nationwide case-crossover study in China

Few national studies have systemically examined the effects of criteria air pollutants on cardiovascular morbidity.This study aimed to investigate the associations between all criteria air pollutants and hospitalization of causespecific cardiovascular diseases(CVD)in China.We obtained data on CVD hospitalization events of four major categories and 12 specific diseases from 153 hospitals distributed in 20 provincial-level regions from 2013 to 2020.We adopted a time-stratified case-crossover study design using individual cases to capture the effect of short-term exposure to six criteria air pollutants on CVD hospitalizations,using conditional logistic regression models.More than 1.1 million CVD hospitalization events were included.The lag pattern exploration demonstrated the largest effect for six air pollutants on lag 0–1 day.PM_(2.5),PM_(10),NO_(2),and CO were significantly associated with increased hospitalization from ischemic heart diseases,cerebrovascular diseases,other heart diseases,and five specific causes of CVD.The effect estimates of NO_(2)were the most robust when adjusting for copollutants.The concentration-response curves were positive and linear for most pollutant–endpoint pairs(except for O_(3)),and these positive associations remained even below the 24-h levels recommended by WHO Air Quality Guidelines and China Air Quality Standards.This nationwide case-crossover study in China demonstrated that short-term exposure to multiple ambient air pollutants may significantly increase the risk of cause-specific CVD hospitalizations even under the most stringent air quality regulations,striking an alert for potential CVD patients against these environmental risk factors.