연구정보
[보건] Simplified Chronic Hepatitis B Antiviral Initiation Criteria in Thailand: An Economic Evaluation
태국 국외연구자료 연구보고서 - Value in Health Regional Issues 발간일 : 2024-06-07 등록일 : 2024-06-14 원문링크
Chronic hepatitis B (CHB) is a major risk factor for hepatocellular carcinoma (HCC), causing approximately half of all HCC cases worldwide. Early diagnosis and treatment are essential to prevent these complications, but only 1.7% of people with hepatitis B virus (HBV) are aware of their condition and receive treatment. The World Health Organization has set goals to reduce the number of new cases of HBV infection by 90% and the number of deaths from HBV-related causes by 65% by 2030.
Several guidelines recommend antiviral therapy for patients with CHB. Entecavir (ETV), tenofovir disoproxil fumarate (TDF), and tenofovir alafenamide (TAF) all have relatively similar effects on reducing the risk of HCC.
Several laboratory tests are needed to assess whether patients with CHB should start antiviral treatment. In particular, in Thailand, patients with CHB are recommended to start antiviral treatment if they had (1) hepatitis B surface antigen (HBsAg) positive for at least 6 months, (2) viral load (HBV deoxyribonucleic acid [DNA]) ≥2000 IU/mL, (3) alanine transaminase (ALT) level ≥2 times of upper normal limit, (4) fibrosis stage Metavir >2 or clinical cirrhosis or hepatic decompensation, (5) high ALT level but <2 times of upper normal limit with confirmed necroinflammation or significant fibrosis, and (6) normal ALT level but had significant risk factors for HCC including male aged >40 years old with a family history of HCC. Because the criteria are relatively complex, hepatologists are required to decide whether patients should start antiviral treatment. However, the number of hepatologists in Thailand is limited and is not well distributed to all areas, resulting in limited patient accessibility to antiviral treatment.
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