Effort called for on hepatitis in China

China needs to increase chronic viral hepatitis care and treatment nationwide to reduce costly complications, economic hardship and deaths from cirrhosis and liver cancer, according to a Stanford University expert.

An estimated 100 million people in China are living with chronic hepatitis B (CHB) infection, or 25 percent of the world’s total, making it the most prevalent life-threatening disease in the country, said Samuel So, a professor at Stanford’s School of Medicine.

Although newborn hepatitis B immunization has successfully reduced the prevalence of CHB in children, the disease, if left untreated, can lead to serious liver damage.

Some 350,000-500,000 deaths are reported each year from virusrelated diseases, said So, who is also the founder and director of the Asian Liver Center at the university, which is committed to reducing the high rates of CHB and liver cancer in the Asian- American communities and in Asia.

In 2015, an estimated 425,000 people in China died of liver cancer. The WHO International Agency for Research on Cancer estimates that the number of deaths from liver cancer will continue to rise, to about 630,000 by 2030.

“Despite the availability of effective therapies, there is no national policy in place to cover hepatitis B treatment, and many patients, particularly those with rural health plans, can’t afford it,” So said.

Two highly effective and low-resistance drugs for treatment of CHB are entecavir and tenofovir, but their high prices put them out of reach for most people in China until in May this year, when GSK dropped the price of tenofovir from 1,500 yuan ($225) to 490 yuan per month.

However, in most rural areas, there is only access to liver supplements and the less- effective, high-resistance medicine like lamivudine, but still no access to those two highly effective medications, So said.

“The government can change that,” he added.

Last year, So and his team did a study to present evidence to the policymakers in China about the costeffectiveness of all the CHB treatments available in China.

They found the interferon treatment was not cost-effective, and the tenofovir treatment would be costeffective if the price of tenofovir in China were the same as the government gets to treat HIV.

The study also provides policymakers a tenofovir and entercavir price threshold or price break point for them to be “cost saving”, “highly cost effective” or “cost effective”.

To help increase access to treatment in rural areas, the center partnered with the Qinghai government and Chinese Center for Disease Control and Prevention and provided free hepatitis B vaccinations to immunize more than 500,000 unvaccinated children in the Northwest China province from 2006 to 2008.

The center also collaborated with Qinghai and Gansu provinces on a pilot project to educate healthcare workers and pregnant women to improve their health system capacity to prevent mother-to-child transmission of hepatitis B from 2012 to 2014.

This year, the center expanded the program province-wide and also launched a demonstration project to test the babies born to hepatitis B-infected mothers after vaccination to make sure they are protected and to see whether they need to be revaccinated.

By making hepatitis B newborn vaccinations a national public health priority, China has prevented 28 million children from developing chronic hepatitis B and 5 million future deaths from hepatitis B-related cirrhosis and liver cancer, So said.

“China’s success in hepatitis newborn vaccination has served as a model for the world to follow,” said So.