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Open Access Research article

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

Monica C Robotin12*, Melanie Q Kansil3, Jacob George45, Kirsten Howard1, Steven Tipper2, Miriam Levy67, Nghi Phung8 and Andrew G Penman2

Author Affiliations

1 School of Public Health, University of Sydney NSW, Sydney, Australia

2 Cancer Council NSW, Woolloomooloo NSW, Australia

3 Centaurus Partners, Kensington NSW, Australia

4 Storr Liver Unit, Millennium Institute, Westmead NSW, Australia

5 School of Medicine, University of Sydney NSW, Sydney, Australia

6 Department of Gastroenterology, Liverpool Hospital, Liverpool NSW, Australia

7 University of New South Wales, Sydney NSW, Australia

8 Departments of Gastroenterology and Addiction Medicine, Westmead Hospital, Westmead NSW, Australia

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BMC Health Services Research 2010, 10:215  doi:10.1186/1472-6963-10-215

Published: 21 July 2010

Abstract

Background

Australians born in countries where hepatitis B infection is endemic are 6-12 times more likely to develop hepatocellular cancer (HCC) than Australian-born individuals. However, a program of screening, surveillance and treatment of chronic hepatitis B (CHB) in high risk populations could significantly reduce disease progression and death related to end-stage liver disease and HCC. Consequently we are implementing the B Positive pilot project, aiming to optimise the management of CHB in at-risk populations in south-west Sydney. Program participants receive routine care, enhanced disease surveillance or specialist referral, according to their stage of CHB infection, level of viral load and extent of liver injury. In this paper we examine the program's potential impact on health services utilisation in the study area.

Methods

Estimated numbers of CHB infections were derived from Australian Bureau of Statistics data and applying estimates of HBV prevalence rates from migrants' countries of birth. These figures were entered into a Markov model of disease progression, constructing a hypothetical cohort of Asian-born adults with CHB infection. We calculated the number of participants in different CHB disease states and estimated the numbers of GP and specialist consultations and liver ultrasound examinations the cohort would require annually over the life of the program.

Results

Assuming a 25% participation rate among the 5,800 local residents estimated to have chronic hepatitis B infection, approximately 750 people would require routine follow up, 260 enhanced disease surveillance and 210 specialist care during the first year after recruitment is completed. This translates into 5 additional appointments per year for each local GP, 25 for each specialist and 420 additional liver ultrasound examinations.

Conclusions

While the program will not greatly affect the volume of local GP consultations, it will lead to a significant increase in demand for specialist services. New models of CHB care may be required to aid program implementation and up scaling the program will need to factor in additional demands on health care utilisation in areas of high hepatitis B sero-prevalence.