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Table 1 General assumptions of the Markov model of HCC prevention

From: Using a population-based approach to prevent hepatocellular cancer in New South Wales, Australia: effects on health services utilisation

Assumption

How they were addressed and rationale

Recruitment of B Positive participants

Target population age ≥ 35, HBsAg + ve for ≥ 6 months, born in China, Hong Kong, Vietnam

Contact testing and immunisation

Not factored into the model

Seroprevalence data in target populations

Data provided by Nguyen et al [19]

 

   • 10.7% for people born in China

 

   • 10.5% for people born in Vietnam

 

   • 7.7% for people born in Hong Kong

Initial testing to confirm CHB

Not factored in GP consultation calculations

Program participation rates

Base case assumption is 25% of eligible people enrolled

Follow up requirements

   • Routine surveillance arm: 2 GP appointments/year

 

   • Enhanced HCC surveillance arm: 2 GP appointments/year

 

   • Interferon treatment: 6 specialist appointments/year

 

   • Entecavir treatment (includes those with liver failure): 4 specialist appointments/year

 

   • Patients with HCC: assumed monthly follow up

Viral load distribution by age

Based upon REVEAL study, [22] as participant profile largely matches that of B Positive participants

ALT cut-off levels

ALT≥ 1.5 × ULN triggers further evaluation in the absence of clinical data; ULN differentiated by participant age

Progression rates through disease stages

Constant over time

Patients with high VL and abnormal liver function

30% receive first line interferon for 12 months

 

   • 30% seroconvert and receive no further treatment

 

   • 70% commence entecavir the following year

 

70% receive entecavir as first-line treatment

 

   • 20% seroconvert in the first year of entecavir treatment and receive no further treatment

 

   • 80% continue lifelong entecavir

Patients with liver failure

All receive entecavir

  1. VL: viral load
  2. ALT: alanine aminotransferase
  3. HBsAg: hepatitis B surface antigen