The quest for a cure for chronic hepatitis B from an HTA perspective:lessons learned from chronic hepatitis c

Despite the availability of treatments and vaccines, chronic hepatitis B (CHB) is among the world's deadliest infectious diseases and a global public health concern. This thesis focuses on the quest for curative treatments for CHB from a Health Technology Assessment (HTA) perspective and the evidence/data required by HTA and reimbursement bodies to evaluate new products. New direct antivirals have recently been introduced for hepatitis C and this experience can be built on in hepatitis B, although there are both similarities and differences between hepatitis C and B viruses and related chronic diseases. The second and third chapters focus on hepatitis C with possible directions for future research and development on CHB.Chapter 4 concerns an analysis of data on US Veterans patients, showing the high clinical and economic burden of CHB in this population. Chapter 5 highlights that self-stigma and social stigma are common among patients living with CHB. Chapter 6 addresses patient preferences and shows that one of the main desired attributes of new treatments is limited duration and the ability to achieve sustained HBsAg loss. Chapters 7 and 8 describe a network meta-analysis of clinical trials in CHB, and a systematic review of the literature about health economics models; these findings can be used to adapt cost-effectiveness models.Adequate collection and provision of the data required by HTA agencies and payers and learning from experience in hepatitis C will optimize patient access to new treatments for HBV and accelerate WHO's ambitious goal of eliminating viral hepatitis