ABSTRACT
The competence network for viral hepatitis (HepNet) was founded in 2002 with funding from the German government and has influenced the research on viral hepatitis in Germany. HepNet collaborator sites have been involved in numerous national and international investigator-initiated, as well as industry-sponsored, phase 1-3 studies. Within the HepNet Study-House, many groundbreaking investor-initiated trials have been completed and are still ongoing. For example, the acute hepatitis C trials and trials on chronic hepatitis D (delta), which led to therapy optimization. Continuation of the competence network on viral hepatitis has been achieved by the foundation of the German Liver Foundation, which has been an external cooperation partner of the German Center for Infection Research (DZIF) for two years. The well-established HepNet Study-House acts here as the clinical trial platform for all DZIF hepatitis trials.
Subject(s)
Biomedical Research/organization & administration , Clinical Competence , Foundations/organization & administration , Government Programs/organization & administration , Hepatitis, Viral, Human/prevention & control , National Health Programs/organization & administration , Clinical Trials as Topic/organization & administration , Gastroenterology/organization & administration , Germany/epidemiology , Hepatitis, Viral, Human/epidemiology , Humans , Interinstitutional Relations , Models, Organizational , Program Evaluation , Quality Assurance, Health Care/organization & administrationABSTRACT
The costs of guideline-based treatment are unknown for most diseases. This also applies for economically significant infectious diseases like viral hepatitis and HIV. On the basis of the "German Guidelines for the Management of HBV Infection" from 2011 patients were grouped into HBsAg-positive, immuntolerant and chronic hepatitis patients with and without cirrhosis. Costs were divided in baseline diagnostics, monitoring and medical treatment according to the guideline. The calculation was modelled for a period of five years. Costs for virological diagnostics and imaging account for a large proportion of diagnostic costs. The main cost factors are expenses for pharmaceutical treatment with interferon or HBV polymerase inhibitors. On the assumption that only 25 % of the infected patients are diagnosed, 5-year total costs in Germany account for more than 2.5 billion Euros. Therefore, chronic hepatitis B is a disease with a very high economic burden. The aim of a guideline treatment is to prevent the development of cirrhosis with all its complications as well as the development of liver-cell carcinoma. Prophylactic vaccination against hepatitis B should be advised also considering the potential economic impact.
Subject(s)
Delivery of Health Care/economics , Guideline Adherence/economics , Health Care Costs/statistics & numerical data , Hepatitis B/economics , Hepatitis B/therapy , Practice Guidelines as Topic , Adolescent , Adult , Female , Germany/epidemiology , Hepatitis B/epidemiology , Humans , Male , Middle Aged , Prevalence , Young AdultABSTRACT
BACKGROUND AND AIM: Hepatitis B is a significant health burden in Germany. The aim of this study was (I) to gain more information on knowledge of hepatitis B patients and patient management considering epidemiologic and socio-economic factors, (II) to investigate the knowledge of relatives of patients with hepatitis B about liver disease, modes of infection and possibilities of prevention. PATIENTS AND METHODS: Structured questionnaires were sent to 1000 patients with hepatitis B as a project of the Model Region North of the German network of excellence for viral hepatitis. The patients were asked to forward additional questionnaires to their relatives and household members. RESULTS: 312 (31 %) questionnaires were sent back and evaluated. The majority of responding patients had an immigration background (75 %). The knowledge of hepatitis B patients about their disease status was very heterogeneous. While most of them were aware of their ALT-values, only some patients knew their HBV viral loads. Patients with a low socio-economic status consulted physicians more often but did not receive medical examinations more frequently. The knowledge of relatives (384 relatives from families of 216 patients) about the mode of transmission and the possibilities of prevention were also heterogeneous. Only 84 % of the partners and children were vaccinated against hepatitis B and only 75 % of relatives knew that condoms protect against HBV infection. CONCLUSION: Not only patients with hepatitis B but also relatives and household members should be informed about consequences of liver disease and HBV infection. The poor vaccination coverage even of sexual partners of HBV-infected individuals requires attention and should lead to a better education.
