Health Economic Analysis and Medical Cost Analysis of Children with Severe Hepatitis B in China: A Retrospective Study from 2016 to 2022

0
0
0

Health Economic Analysis and Medical Cost Analysis of Children with Severe Hepatitis B in China: A Retrospective Study from 2016 to 2022

Introduction

Hepatitis B virus (HBV) infection remains a significant public health challenge globally, particularly in China, where vertical transmission contributes to a high burden of pediatric cases. While most childhood HBV infections are asymptomatic, severe cases requiring hospitalization can lead to liver failure, cirrhosis, or hepatocellular carcinoma. Despite the implementation of universal HBV vaccination programs, gaps persist in understanding the economic burden and spatial distribution of severe pediatric hepatitis B cases. This study provides a comprehensive analysis of disease characteristics, hospitalization costs, and regional disparities in severe pediatric hepatitis B across China from 2016 to 2022.

Methodology

Data Sources

The study utilized data from the Hospital Quality Monitoring System (HQMS), a national database covering 31 provincial administrative regions. Pediatric cases (aged 0–17 years) diagnosed with hepatitis B (ICD-10 codes: B16, B18.0–B18.1, B18.10–B18.11, B19.10) between January 2016 and April 2022 were included. Cases with incomplete cost or demographic data were excluded.

Classification and Variables

Patients were stratified into four age groups: 0–4, 5–9, 10–14, and 15–17 years. Disease severity was categorized as hepatitis, liver failure, cirrhosis, or liver cancer. Complications such as portal hypertension, ascites, gastrointestinal hemorrhage, and hepatic encephalopathy were analyzed. Hospitalization costs were adjusted for inflation and converted to USD (exchange rate: 1 USD = 6.5 CNY).

Spatial analysis employed Moran’s I to assess regional clustering of cases and correlations with economic indicators (GDP, urban population ratio, pediatric bed density). Data on GDP levels and healthcare resources were sourced from the National Bureau of Statistics and National Health Commission.

Statistical Analysis

Descriptive statistics summarized demographic and clinical characteristics. Median hospitalization costs were reported due to non-normal distributions. Linear regression identified cost predictors (e.g., length of stay, organ failure). Spatial autocorrelation and bivariate Moran’s I analyses evaluated geographic and economic associations.

Results

Patient Characteristics

A total of 1,603 pediatric hepatitis B cases were analyzed (69.7% male, 30.3% female). The mean age was 10.5 years, with the highest proportion of cases in the 15–17 age group (41.0%, 658/1,603). Liver failure was the most common complication (43.5%, 697/1,603), followed by cirrhosis (11.2%, 180/1,603) and ascites (7.1%, 114/1,603). Co-infections with hepatitis D (4.0%, 64/1,603) and drug-induced hepatitis (2.7%, 43/1,603) were noted, with the latter predominantly in adolescents (15–17 years: 5.6%, 24/658).

Age-specific variations emerged:

  • 0–4 years: Higher rates of cirrhosis (10.7%, 42/393) and hepatitis D co-infection (8.4%, 33/393).
  • 15–17 years: Elevated liver failure (56.1%, 369/658) and cirrhosis (14.4%, 95/658).
  • 10–14 years: Highest prevalence of liver cancer (6.4%, 23/359).

Hospitalization Costs

Median hospitalization costs varied by disease progression and age:

  • Uncomplicated hepatitis: $818.12 (range: $593.14–$980.99), with costs increasing with age.
  • Advanced complications:
    • Liver failure alone: $851.04 (0–4 years) to $1,601.61 (15–17 years).
    • Multi-organ failure: Costs escalated sharply, e.g., liver + renal failure in 10–14 years: $24,440.39.
    • Stage 4 disease (encephalopathy): Highest median cost ($10,567.51) for cases with concurrent portal hypertension and ascites.

Cost predictors included prolonged hospitalization (β = 0.42, P < 0.001), liver failure (β = 0.18, P = 0.002), and respiratory failure (β = 0.21, P < 0.001). From 2016 to 2022, costs for uncomplicated hepatitis decreased by 32% ($1,231.60 to $555.77).

Spatial and Economic Correlations

Geographic clustering was observed in southwestern provinces (Sichuan, Yunnan, Guizhou) and central China (Hunan, Hubei). Moran’s I revealed significant spatial aggregation at the prefectural level in 2019 (I = 0.294, P = 0.010), 2020 (I = 0.115, P = 0.085), and 2021 (I = 0.205, P = 0.029).

Key economic correlations:

  • Negative associations: Higher GDP (Moran’s I = –0.217 to –0.279, P < 0.05) and urban population ratio (I = –0.240 to –0.309, P < 0.01) correlated with fewer cases.
  • Positive association: Pediatric bed density (I = 0.214–0.252, P < 0.01) linked to higher case numbers, suggesting regional disparities in healthcare access.

Discussion

Disease Burden and Clinical Implications

The predominance of liver failure and cirrhosis among adolescents underscores the need for early screening and monitoring. Vertical transmission likely contributes to cirrhosis in younger children (0–4 years), while adolescents face risks from delayed diagnosis and antiviral therapy non-adherence. The high prevalence of drug-induced hepatitis in older groups highlights the need for public health interventions targeting substance misuse.

Economic and Regional Disparities

Lower GDP regions exhibited higher case numbers, reflecting gaps in vaccination coverage, healthcare infrastructure, and health literacy. Rural areas with limited access to prenatal HBV screening and postnatal vaccination programs are particularly vulnerable. The inverse correlation with urban population ratios suggests urbanization’s protective effect, likely due to better healthcare access and awareness.

Cost Trends and Policy Recommendations

Declining hospitalization costs for uncomplicated hepatitis may reflect improved outpatient management and earlier interventions. However, escalating costs for multi-organ failure emphasize the economic imperative of preventing disease progression. Regional disparities in pediatric bed density indicate the need for targeted resource allocation to high-burden areas.

Limitations

The study’s reliance on HQMS data limits insights into treatment protocols and long-term outcomes. Lack of virological data (e.g., HBV DNA levels) and vaccination histories restricts analysis of disease progression drivers.

Conclusion

This study provides critical insights into the epidemiology, economic burden, and geographic distribution of severe pediatric hepatitis B in China. Key findings advocate for enhanced vaccination programs in rural and low-GDP regions, booster dose strategies for adolescents, and equitable healthcare resource distribution. Addressing these challenges will mitigate the clinical and economic impacts of pediatric HBV infection.

doi.org/10.1097/CM9.0000000000002987

Was this helpful?

0 / 0