A Simulation Shows That Early Treatment Of Chronic Hepatitis B Infection Can Cut Deaths And Be Cost-Effective

Post, Sarah E.; Sodhi, Neetu Khurana; Peng, Chia-hui; Wan, Kejia; Pollack, Henry

doi:10.1377/hlthaff.2008.0905

Cited by 36 publications

(27 citation statements)

References 38 publications

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“…17 Providing care and treatment to people with hepatitis B infection has been shown to be a highly cost-effective use of health care spending, “buying” additional years of healthy, productive life at a lower cost than required for many comparable interventions. 17,18 However, because of the chronic nature and slow progression of the disease, we were unable to assess our program’s cost-effectiveness.…”

Section: Program Assessmentmentioning

confidence: 99%

A Comprehensive Screening And Treatment Model For Reducing Disparities In Hepatitis B

Pollack

Wang

Wyatt³

et al. 2011

Health Affairs

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Chronic hepatitis B affects Asian Americans at a much higher rate than the general US population. Appropriate care can limit morbidity and mortality from hepatitis B. However, access to care for many Asian Americans and other immigrant groups is limited by their lack of knowledge about the disease, as well as cultural, linguistic, and financial challenges. This article describes the results of BfreeNYC, a New York City pilot program that, from 2004 to 2008, provided hepatitis B community education and awareness, free screening and vaccinations, and free or low-cost treatment primarily to immigrants from Asia, but also to residents from other racial and ethnic minority groups. The program was the largest citywide screening program in the United States, reaching nearly 9,000 people, and the only one providing comprehensive care to those who were infected. During the program, new hepatitis B cases reported annually from predominantly Asian neighborhoods in the city increased 34 percent. More than two thousand people were vaccinated; 57 percent of the 1,162 patients who tested positive for hepatitis B and were evaluated by program clinical services were still in care at the end of the program. Our analysis found that the program was effective in reaching the target population and providing care. Although follow-up care data will be needed to demonstrate long-term costeffectiveness, the program may serve as a useful prototype for addressing hepatitis B disparities in communities across the United States.

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Section: Program Assessmentmentioning

confidence: 99%

A Comprehensive Screening And Treatment Model For Reducing Disparities In Hepatitis B

Pollack

Wang

Wyatt³

et al. 2011

Health Affairs

Self Cite

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show abstract

“…It is estimated that the majority of HBV-infected individuals are undiagnosed, and those who are aware of their infection are not receiving recommended medical care (4–6). Early identification and appropriate disease management can reduce the risk of HBV-related complications, namely hepatocellular carcinoma (HCC) and end-stage liver disease (1, 7–9), and is cost-effective in the long-term (10, 11). Despite this, recent studies highlight inadequate monitoring and treatment of at-risk HBV-infected patients (6, 12, 13), and given the negative clinical consequences of chronic infection, improving HBV disease management has been highlighted as a public health priority (14).…”

Section: Introductionmentioning

confidence: 99%

Hepatitis B Management in Vulnerable Populations: Gaps in Disease Monitoring and Opportunities for Improved Care

et al. 2013

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Background Hepatitis B (HBV) is prevalent in certain US populations and regular HBV disease monitoring is critical to reducing associated morbidity and mortality. Adherence to established HBV monitoring guidelines among primary care providers is unknown. Aims To evaluate HBV disease monitoring patterns and factors associated with adherence to HBV management guidelines in the primary care setting. Methods Primary providers within the San Francisco safety net healthcare system were surveyed for HBV management practices, knowledge, attitudes, and barriers to HBV care. Medical records from 1,727 HBV-infected patients were also reviewed retrospectively. Results Of 148 (45%) responding providers, 79% reported ALT and 44% reported HBV viral load testing every 6–12 months. Most providers were knowledgeable about HBV but 43% were unfamiliar with HBV management guidelines. Patient characteristics included: mean age 51 years; 54% male; 67% Asian. Within the past year, 75% had ALT; 24% viral load; 21% HBeAg tested, and 40% of at-risk patients had abdominal imaging for HCC. Provider familiarity with guidelines (OR 1.02, 95%CI 1.00–1.03), Asian patient race (OR 4.18, 95%CI 2.40–7.27), and patient age were associated with recommended HBV monitoring. Provider HBV knowledge and attitudes were positively associated, while provider age and perceived barriers were negatively associated with HCC surveillance. Conclusions Comprehensive HBV disease monitoring including HCC screening with imaging were suboptimal. While familiarity with AASLD guidelines and patient factors were associated with HBV monitoring, only provider and practice factors were associated with HCC surveillance. These findings highlight the importance of targeted provider education to improve HBV care.

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“…36 Indeed, the average baseline knowledge score in our sample was approximately 3.4 on a score range from 0 to 7, which indicates that the community in general lacks knowledge on hepatitis B risk and prevention. Given that the HBV knowledge gaps could lead to a low level of HBV screening, increased HBV transmission, delayed treatment, and poorer outcomes, and that HBV screening is the first step in preventing and controlling HBV infection and liver cancer, 37,38 educational intervention for improving HBV knowledge should focus primarily on increasing the knowledge of hepatitis B in this community.…”

Section: Discussionmentioning

confidence: 99%

Psychosocial Predictors of HBV Screening Behavior among Vietnamese Americans

et al. 2017

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Objective We evaluated the influence of psychosocial factors on HBV screening. Methods Sample consisted of 1716 Vietnamese participants in our previous HBV intervention trial, recruited from 36 community-based organizations in Pennsylvania, New Jersey, and New York City between 2009 and 2014. Using the Health Belief Model and Social Cognitive Theory, we measured self-efficacy, knowledge, perceived barriers, perceived benefits, perceived severity, and risk susceptibility. Analysis of covariance was used to compare pre- and post-intervention changes of psychosocial variables. Structural equation modeling was used to explore the direct and indirect effects of the psychosocial variables on HBV screening. Results Knowledge, self-efficacy, perceived benefits, and perceived barriers were directly associated with HBV screening; knowledge had the strongest effect. Perceived severity and risk susceptibility had indirect association with HBV screening through other variables. Indirect paths among the 6 psychosocial variables were also identified. Conclusion To promote HBV screening among Vietnamese Americans, intervention efforts should focus on increasing knowledge, self-efficacy, and perceived benefits, decreasing perceived barriers, and accounting for the dynamic cognitive processing.

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A Simulation Shows That Early Treatment Of Chronic Hepatitis B Infection Can Cut Deaths And Be Cost-Effective

Cited by 36 publications

References 38 publications

A Comprehensive Screening And Treatment Model For Reducing Disparities In Hepatitis B

A Comprehensive Screening And Treatment Model For Reducing Disparities In Hepatitis B

Hepatitis B Management in Vulnerable Populations: Gaps in Disease Monitoring and Opportunities for Improved Care

Psychosocial Predictors of HBV Screening Behavior among Vietnamese Americans

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