Global hepatitis B prevention and treatment : models and insights
- David William Hutton.
- June 2010.
- Physical description
- online resource (xii, 118 pages) : illustrations (some color)
- Hutton, David William.
- Brandeau, Margaret L. thesis advisor (primary).
- Owens, Douglas K. thesis advisor.
- So, Samuel. thesis advisor.
- Stanford University. Committee on Graduate Studies.
- Stanford University. Department of Management Science and Engineering.
- Includes bibliographical references (p. 106-118).
- Hepatitis B (HBV) is a vaccine-preventable viral disease that, if untreated, can lead to death from liver disease in 25 percent of patients. Infection with HBV is a major global public health problem, particularly in Asian populations. In an era of limited healthcare budgets, mathematical models can be useful tools to identify cost-effective programs and to support policymakers in making informed decisions. This dissertation describes research on public health policies related to screening, vaccination, and treatment for HBV. It also describe contributions to the theoretical literature on when to stop catch-up vaccination for chronic infectious diseases. In the United States as many as 10% of Asian and Pacific Islander adults are chronically infected with HBV, and up to two thirds are unaware that they are infected. Using Markov models of infection, treatment and disease, I find that screening programs for HBV among Asian and Pacific Islander adults are likely to be cost effective and have clinically significant benefits from identifying chronically infected persons for medical management. Liver disease associated with childhood-acquired HBV is a leading cause of death among adults in China. Approximately 20% of children under age 5 years and 40% of children aged 5 to 19 years remain unprotected from HBV. Using a Markov model of infection and disease progression I find that HBV catch-up vaccination for children and adolescents in China would improve the health of the population and save costs over the long term. Although the 20th century has seen incredible development of safe and effective vaccines, many people remain susceptible to vaccine-preventable diseases. "Catch-up vaccination" for age groups beyond infancy can be an attractive and effective means of immunizing people who were missed earlier. However, as vaccination rates increase, catch-up vaccination may become less attractive. This chapter addresses the question of when to discontinue catch-up vaccination programs as immunization rates increase. I use a cost-effectiveness framework: I consider the cost per quality-adjusted life year gained of catch-up vaccination efforts, as a function of immunization rates over time and consequent disease prevalence and incidence. I illustrate the results with the example of HBV catch-up vaccination in China. I contrast results from a dynamic modeling approach with an approach that ignores the impact of vaccination on disease incidence.
- Hepatitis B Vaccines > economics
- Immunization Schedule
- Vaccination > economics
- Vaccination > statistics & numerical data
- Models, Theoretical
- United States
- Publication date
- Submitted to the Department of Management Science and Engineering and the Committee on Graduate Studies of Stanford University.
- Thesis (Ph.D.)--Stanford University, 2010.