Markov modeling in hepatitis B screening and linkage to care

Markov modeling in hepatitis B screening and linkage to care

With up to 240 million people chronically infected with hepatitis B worldwide, including an estimated 2 million in the United States, widespread screening is needed to link the infected to care and decrease the possible consequences of untreated infection, including liver cancer, cirrhosis and death...

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Bibliographic Details
Published in:Theoretical biology and medical modelling Vol. 14; no. 1; p. 11
Main Authors: Sehr, Martin A, Joshi, Kartik D, Fontanesi, John M, Wong, Robert J, Bitmead, Robert R, Gish, Robert G
Format: Journal Article
Language:English
Published: England BioMed Central 18-05-2017
Subjects:
Cancer
Cirrhosis
Complications
Computer Simulation
Death
Hepatitis
Hepatitis B
Hepatitis B - diagnosis
Humans
Infections
Interferon
Life expectancy
Life span
Liver
Liver cancer
Liver cirrhosis
Markov analysis
Markov Chains
Mass Screening
Models, Biological
Mortality
Parameter sensitivity
Patient Care
Patients
Point-of-Care Systems
Probability theory
Screening
Sensitivity
Sensitivity analysis
Standard of care
Stochasticity
Test procedures
United States > US
Markov modeling
Screening
Hepatitis B virus
Point-of-care
Standard-of-care
Testing
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Summary:With up to 240 million people chronically infected with hepatitis B worldwide, including an estimated 2 million in the United States, widespread screening is needed to link the infected to care and decrease the possible consequences of untreated infection, including liver cancer, cirrhosis and death. Screening is currently fraught with challenges in both the developed and developing world. New point-of-care tests may have advantages over standard-of-care tests in terms of cost-effectiveness and linkage to care. Stochastic modeling is applied here for relative utility assessment of point-of-care tests and standard-of-care tests for screening. We analyzed effects of point-of-care versus standard-of-care testing using Markov models for disease progression in individual patients. Simulations of large cohorts with distinctly quantified models permitted the assessment of particular screening schemes. The validity of the trends observed is supported by sensitivity analyses for the simulation parameters. Increased utilization of point-of-care screening was shown to decrease hepatitis B-related mortalities and increase life expectancy at low projected expense. The results suggest that standard-of-care screening should be substituted by point-of-care tests resulting in improved linkage to care and decrease in long-term complications.
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ISSN:1742-4682
1742-4682
DOI:10.1186/s12976-017-0057-6