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Hamberg MLS, Dupont L, Jønsson MF, Bennick H, Teisner AS, Andersen ML, Konradsen H, Danielsen A. A Nurse-Led Outpatient Clinic for Patients With Decompensated Liver Cirrhosis: Staffing, Structure, and Patient Satisfaction. Gastroenterol Nurs 2023; 46:107-117. [PMID: 36882915 DOI: 10.1097/sga.0000000000000706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/29/2022] [Indexed: 03/09/2023] Open
Abstract
Patients with decompensated liver cirrhosis constitute a growing and vulnerable patient group with a particular need for easy outpatient access and close follow-up. By establishing a nurse-led clinic, we aimed to counter this need in a patient-centered manner within a multidisciplinary rehabilitating framework. This article presents the organization, staffing, and structure of this initiative as well as the patient population demographics and characteristics. Furthermore, patient satisfaction within the clinic was explored. Two complementary substudies are presented: a descriptive, registry-based journal audit, presenting data from the clinic's first years, 2017-2019, and a cross-sectional, descriptive survey, exploring patient satisfaction 2 years later. Different visit types with predefined content constitute an operable structure suitable for meeting patients' current needs. An increase in both the number of patients and visits from the first to second years indicates an existing need for nurse-led support. Data not only support the well-known characteristics of patients with cirrhosis but also add to a broader perspective with more nuances for this patient population. The survey shows an overall high score on satisfaction but also points out areas for improvement. The nurse-led clinic provides both structure and knowledge to facilitate patient-centered treatment and care for those suffering from liver cirrhosis.
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Affiliation(s)
- Marie Louise S Hamberg
- Marie Louise S. Hamberg, RN, is clinical nurse, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Lene Dupont, RN, is clinical nurse, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Marthe F. Jønsson, RN, is clinical nurse, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Hanne Bennick, RN, is clinical nurse, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Ane S. Teisner, MD, is physician, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Mette L. Andersen, MD, is physician, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Hanne Konradsen, PhD, is Professor, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark, and Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Anne Danielsen, PhD, is Associate Professor, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lene Dupont
- Marie Louise S. Hamberg, RN, is clinical nurse, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Lene Dupont, RN, is clinical nurse, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Marthe F. Jønsson, RN, is clinical nurse, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Hanne Bennick, RN, is clinical nurse, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Ane S. Teisner, MD, is physician, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Mette L. Andersen, MD, is physician, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Hanne Konradsen, PhD, is Professor, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark, and Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Anne Danielsen, PhD, is Associate Professor, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marthe F Jønsson
- Marie Louise S. Hamberg, RN, is clinical nurse, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Lene Dupont, RN, is clinical nurse, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Marthe F. Jønsson, RN, is clinical nurse, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Hanne Bennick, RN, is clinical nurse, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Ane S. Teisner, MD, is physician, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Mette L. Andersen, MD, is physician, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Hanne Konradsen, PhD, is Professor, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark, and Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Anne Danielsen, PhD, is Associate Professor, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Bennick
- Marie Louise S. Hamberg, RN, is clinical nurse, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Lene Dupont, RN, is clinical nurse, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Marthe F. Jønsson, RN, is clinical nurse, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Hanne Bennick, RN, is clinical nurse, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Ane S. Teisner, MD, is physician, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Mette L. Andersen, MD, is physician, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Hanne Konradsen, PhD, is Professor, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark, and Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Anne Danielsen, PhD, is Associate Professor, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ane S Teisner
- Marie Louise S. Hamberg, RN, is clinical nurse, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Lene Dupont, RN, is clinical nurse, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Marthe F. Jønsson, RN, is clinical nurse, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Hanne Bennick, RN, is clinical nurse, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Ane S. Teisner, MD, is physician, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Mette L. Andersen, MD, is physician, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Hanne Konradsen, PhD, is Professor, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark, and Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Anne Danielsen, PhD, is Associate Professor, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mette L Andersen
- Marie Louise S. Hamberg, RN, is clinical nurse, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Lene Dupont, RN, is clinical nurse, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Marthe F. Jønsson, RN, is clinical nurse, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Hanne Bennick, RN, is clinical nurse, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Ane S. Teisner, MD, is physician, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Mette L. Andersen, MD, is physician, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Hanne Konradsen, PhD, is Professor, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark, and Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Anne Danielsen, PhD, is Associate Professor, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Konradsen
- Marie Louise S. Hamberg, RN, is clinical nurse, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Lene Dupont, RN, is clinical nurse, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Marthe F. Jønsson, RN, is clinical nurse, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Hanne Bennick, RN, is clinical nurse, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Ane S. Teisner, MD, is physician, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Mette L. Andersen, MD, is physician, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Hanne Konradsen, PhD, is Professor, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark, and Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Anne Danielsen, PhD, is Associate Professor, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Danielsen
- Marie Louise S. Hamberg, RN, is clinical nurse, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Lene Dupont, RN, is clinical nurse, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Marthe F. Jønsson, RN, is clinical nurse, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Hanne Bennick, RN, is clinical nurse, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Ane S. Teisner, MD, is physician, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Mette L. Andersen, MD, is physician, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Hanne Konradsen, PhD, is Professor, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark, and Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Anne Danielsen, PhD, is Associate Professor, Department of Gastroenterology and Hepatology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Ngu NL, Saxby E, Worland T, Anderson P, Stothers L, Figredo A, Hunter J, Elford A, Ha P, Hartley I, Roberts A, Seah D, Tambakis G, Liew D, Rogers B, Sievert W, Bell S, Le S. A home-based, multidisciplinary liver optimisation programme for the first 28 days after an admission for acute-on-chronic liver failure (LivR well): a study protocol for a randomised controlled trial. Trials 2022; 23:744. [PMID: 36064596 PMCID: PMC9444080 DOI: 10.1186/s13063-022-06679-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 08/20/2022] [Indexed: 11/22/2022] Open
Abstract
Background Acute-on-chronic liver failure (ACLF) represents a rising global healthcare burden, characterised by increasing prevalence among patients with decompensated cirrhosis who have a 28-day transplantation-free mortality of 33.9%. Due to disease complexity and a high prevalence of socio-economic disadvantage, there are deficits in quality of care and adherence to guideline-based treatment in this cohort. Compared to other chronic conditions such as heart failure, those with liver disease have reduced access to integrated ambulatory care services. The LivR Well programme is a multidisciplinary intervention aimed at improving 28-day mortality and reducing 30-day readmission through a home-based, liver optimisation programme implemented in the first 28 days after an admission with either ACLF or hepatic decompensation. Outcomes from our feasibility study suggest that the intervention is safe and acceptable to patients and carers. Methods We will recruit adult patients with chronic liver disease from the emergency departments, in-patient admissions, and an ambulatory liver clinic of a multi-site quaternary health service in Melbourne, Australia. A total of 120 patients meeting EF-Clif criteria will be recruited to the ACLF arm, and 320 patients to the hepatic decompensation arm. Participants in each cohort will be randomised to the intervention arm, a 28-day multidisciplinary programme or to standard ambulatory care in a 1:1 ratio. The intervention arm includes access to nursing, pharmacy, physiotherapy, dietetics, social work, and neuropsychiatry clinicians. For the ACLF cohort, the primary outcome is 28-day mortality. For the hepatic decompensation cohort, the primary outcome is 30-day re-admission. Secondary outcomes assess changes in liver disease severity and quality of life. An interim analysis will be performed at 50% recruitment to consider early cessation of the trial if the intervention is superior to the control, as suggested in our feasibility study. A cost-effectiveness analysis will be performed. Patients will be followed up for 12 weeks from randomisation. Three exploratory subgroup analyses will be conducted by (a) source of referral, (b) unplanned hospitalisation, and (c) concurrent COVID-19. The trial has been registered with the Australian New Zealand Clinical Trials Registry. Discussion This study implements a multidisciplinary intervention for ACLF patients with proven benefits in other chronic diseases with the addition of novel digital health tools to enable remote patient monitoring during the COVID-19 pandemic. Our feasibility study demonstrates safety and acceptability and suggests clinical improvement in a small sample size. An RCT is required to generate robust outcomes in this frail, high healthcare resource utilisation cohort with high readmission and mortality risk. Interventions such as LivR Well are urgently required but also need to be evaluated to ensure feasibility, replicability, and scalability across different healthcare systems. The implications of this trial include the generalisability of the programme for implementation across regional and urban centres. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621001703897. Registered on 13 December 2021. WHO Trial Registration Data Set. See Appendix 1 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06679-x.
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Affiliation(s)
- Natalie Ly Ngu
- Department of Gastroenterology and Hepatology, Monash Health, Level 3, 246 Clayton Rd, Clayton, Victoria, 3168, Australia. .,Faculty of Medicine, Nursing and Health Sciences, Monash University, Wellington Rd, Clayton, Victoria, 3800, Australia.
| | - Edward Saxby
- Department of Gastroenterology and Hepatology, Monash Health, Level 3, 246 Clayton Rd, Clayton, Victoria, 3168, Australia
| | - Thomas Worland
- Department of Gastroenterology and Hepatology, Monash Health, Level 3, 246 Clayton Rd, Clayton, Victoria, 3168, Australia
| | - Patricia Anderson
- Department of Gastroenterology and Hepatology, Monash Health, Level 3, 246 Clayton Rd, Clayton, Victoria, 3168, Australia
| | - Lisa Stothers
- Department of Gastroenterology and Hepatology, Monash Health, Level 3, 246 Clayton Rd, Clayton, Victoria, 3168, Australia
| | - Anita Figredo
- Hospital in the Home, Level 4, 246 Clayton Rd, Clayton, Victoria, 3168, Australia
| | - Jo Hunter
- Department of Gastroenterology and Hepatology, Monash Health, Level 3, 246 Clayton Rd, Clayton, Victoria, 3168, Australia
| | - Alexander Elford
- Department of Gastroenterology and Hepatology, Monash Health, Level 3, 246 Clayton Rd, Clayton, Victoria, 3168, Australia
| | - Phil Ha
- Department of Gastroenterology and Hepatology, Monash Health, Level 3, 246 Clayton Rd, Clayton, Victoria, 3168, Australia
| | - Imogen Hartley
- Department of Gastroenterology and Hepatology, Monash Health, Level 3, 246 Clayton Rd, Clayton, Victoria, 3168, Australia
| | - Andrew Roberts
- Department of Gastroenterology and Hepatology, Monash Health, Level 3, 246 Clayton Rd, Clayton, Victoria, 3168, Australia
| | - Dean Seah
- Department of Gastroenterology and Hepatology, Monash Health, Level 3, 246 Clayton Rd, Clayton, Victoria, 3168, Australia
| | - George Tambakis
- Department of Gastroenterology and Hepatology, Monash Health, Level 3, 246 Clayton Rd, Clayton, Victoria, 3168, Australia
| | - Danny Liew
- Adelaide Medical School, The University of Adelaide, Corner of North Terrace & George St, Adelaide, South Australia, 5000, Australia
| | - Benjamin Rogers
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Wellington Rd, Clayton, Victoria, 3800, Australia.,Hospital in the Home, Level 4, 246 Clayton Rd, Clayton, Victoria, 3168, Australia
| | - William Sievert
- Department of Gastroenterology and Hepatology, Monash Health, Level 3, 246 Clayton Rd, Clayton, Victoria, 3168, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Wellington Rd, Clayton, Victoria, 3800, Australia
| | - Sally Bell
- Department of Gastroenterology and Hepatology, Monash Health, Level 3, 246 Clayton Rd, Clayton, Victoria, 3168, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Wellington Rd, Clayton, Victoria, 3800, Australia
| | - Suong Le
- Department of Gastroenterology and Hepatology, Monash Health, Level 3, 246 Clayton Rd, Clayton, Victoria, 3168, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Wellington Rd, Clayton, Victoria, 3800, Australia
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Xiao Y, Howell J, van Gemert C, Thompson AJ, Seaman CP, McCulloch K, Scott N, Hellard ME. Enhancing the hepatitis B care cascade in Australia: A cost-effectiveness model. J Viral Hepat 2020; 27:526-536. [PMID: 31856377 DOI: 10.1111/jvh.13252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 11/12/2019] [Accepted: 12/07/2019] [Indexed: 02/06/2023]
Abstract
If Australia is to successfully eliminate hepatitis B as a public health threat, it will need to enhance the chronic hepatitis B (CHB) care cascade. This study used a Markov model to assess the impact, cost and cost-effectiveness of scaling up CHB diagnosis, linkage to care and treatment to reach national and international elimination targets for hepatitis B in Australia. Compared to continued current trends, the model calculated the difference in care cascade projection, disability-adjusted life years (DALYs), costs and the incremental cost-effectiveness ratio (ICER), of scaling up CHB diagnosis, linkage to care and treatment to reach: (a) Australia's 2022 national targets and (b) the WHO's 2030 global targets. Achieving the national and WHO targets had ICERs of A$13 435 (A$10 236-A$21 165) and A$14 482 (A$13 031-A$25 641) per DALY averted between 2016 and 2030 in Australia, respectively. However, this excluded implementation and demand generation costs. The ICER for the National Strategy and WHO Strategy remained under A$50 000 per DALY averted if Australia spent up to A$328 or A$538 million, respectively, per annum (for 2016-2030) on implementation and demand generation activities. Sensitivity analysis showed that cost-effectiveness was predominately driven by the cost of CHB treatment and influenced by disease progression rates. Hence for Australia to reach the National Hepatitis B Strategy 2022 targets and WHO Strategy 2030 targets, it requires an improvement in the CHB care cascade. We estimated it is cost-effective to spend up to A$328 million or A$538 million per year to reach the National and WHO Strategy targets, respectively.
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Affiliation(s)
- Yinzong Xiao
- Burnet Institute, Melbourne, Vic, Australia.,Department of Gastroenterology, St Vicent's Hospital, Melbourne, Vic, Australia.,University of Melbourne, Melbourne, Vic, Australia
| | - Jessica Howell
- Burnet Institute, Melbourne, Vic, Australia.,Department of Gastroenterology, St Vicent's Hospital, Melbourne, Vic, Australia.,University of Melbourne, Melbourne, Vic, Australia.,Monash University, Melbourne, Vic, Australia
| | - Caroline van Gemert
- Burnet Institute, Melbourne, Vic, Australia.,University of Melbourne, Melbourne, Vic, Australia
| | - Alexander J Thompson
- Department of Gastroenterology, St Vicent's Hospital, Melbourne, Vic, Australia.,University of Melbourne, Melbourne, Vic, Australia
| | - Christopher P Seaman
- Burnet Institute, Melbourne, Vic, Australia.,Monash University, Melbourne, Vic, Australia
| | - Karen McCulloch
- University of Melbourne, Melbourne, Vic, Australia.,WHO Collaborating Centre for Viral Hepatitis, Melbourne, Vic, Australia.,Victorian Infectious Diseases Reference Laboratory, Melbourne, Vic, Australia.,The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia
| | - Nick Scott
- Burnet Institute, Melbourne, Vic, Australia.,Monash University, Melbourne, Vic, Australia
| | - Margaret E Hellard
- Burnet Institute, Melbourne, Vic, Australia.,University of Melbourne, Melbourne, Vic, Australia.,Monash University, Melbourne, Vic, Australia.,The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia.,School of Population Health, Monash University, Melbourne, Vic, Australia.,Department of Infectious Diseases, Alfred Hospital, Melbourne, Vic, Australia
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