Modeling Progress Toward Elimination of Hepatitis B in Australia

Abstract

Background and Aims Chronic hepatitis B (CHB) is a significant global health concern, and the most prevalent blood‐borne virus in Australia. World Health Organization (WHO) member states have committed to global elimination, with targets to diagnose 90% of people living with CHB, treat 80% of those eligible, and reduce attributable deaths by 65% by the year 2030. Australia has committed to national targets of 80% diagnosed, 20% on treatment, and a 30% reduction in deaths by 2022. Approach and Results We constructed and implemented a mathematical model to estimate the burden of CHB incorporating vaccination, phases of infection, cirrhosis progression, and mortality attributed to decompensated cirrhosis and hepatocellular carcinoma and examined the population‐level impact of antiviral therapy. Diversity was integrated according to migration patterns, CHB prevalence by country of birth, Indigenous status, and age. Modelled outcomes were subjected to multivariate uncertainty analysis. Of the estimated 221,420 people living with CHB in Australia in 2017, 68% were diagnosed and 8.7% were receiving treatment (less than one‐third of those estimated to be eligible). Based on current trends, the proportion of people living with CHB who have been diagnosed will reach 71% by 2022 and 81% by 2030, and treatment uptake will rise to 11.2% by 2022 and 12.9% by 2030, resulting in a 5.7% reduction in CHB‐attributable deaths from 2015 to 2030. CHB treatment has prevented approximately 2,300 deaths in Australia between 2000 and 2017. Conclusions Australia is not on track to meet local and global targets regarding CHB. Comprehensive and regularly updated modelling approaches accounting for diversity within the population are a useful tool to measure progress and impact of interventions, and quantify further improvements required to meet elimination goals.

Liver diseases in the Asia-Pacific region: a Lancet Gastroenterology & Hepatology Commission

“…In 2017, an estimated 149 746 people living with chronic hepatitis B in Australia had been diagnosed, representing 68% of the total estimated population living with chronic hepatitis B and a modest increase from the 63% estimate in 2011. 307 The first National Hepatitis B Strategy 2010-13 308 sought to reduce disease transmission and the morbidity and mortality associated with hepatitis B. Furthermore, the introduction of highly effective HBV antiviral therapy in Australia with entecavir in 2005 and tenofovir in 2007 was accompanied by considerable increases in treatment uptake.…”

“…Modeled trends between 2011 and 2017 show an ongoing modest increase (average 0·93% per year) in this proportion. 307 At the population-level, only a few people with chronic HBV infections (possibly 10-15%) would be recommended for treatment on the basis of national and international consensus guidelines. 309,310 These vaccination efforts are collectively reflected in the fact that Australia was recognised by WHO as meeting the regional control target of hepatitis B, which is a prevalence of less than 1% in children younger than 5 years.…”

Enhancing the hepatitis B care cascade in Australia: A cost‐effectiveness model

“…Previous modelling estimated that 215 264 to 237 894 people were living with CHB in Australia in 2016 . The model was initialized assuming 63.5% of people living with CHB were diagnosed (45.9% without care and 17.6% with care), sourced from modelled data which were estimated from Australian census data, hepatitis B surveillance system and national healthcare/medication subsidy programme (Table ). Health state distributions were assumed to be different for those in care and not in care.…”

“…Despite proportional increases in diagnoses, care engagement and treatment among people living with CHB since 2011, modelling data suggested that current diagnosis rates remain insufficient for Australia to reach the National Strategy or WHO Strategy targets. This suggests further scale‐up of testing, linkage to care and treatment is required, but such activities come at a cost.…”

Progress towards elimination goals for viral hepatitis

“…Because hepatitis B immunoglobulin administration has been challenging in LMICs where MTCT is common, HBV diagnosis and treatment of eligible women of child-bearing age could also be used as a strategy to reduce MTCT 62 . Diagnosis and treatment of more HBV-infected individuals in general is required for HBV elimination [3][4][5] . An important goal for the next decade will be the discovery of agents that functionally cure rather than simply suppress HBV infection.…”