The ABCs and STDs

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China: Hepatitis treatment fails to keep pace with economy


According to a statement recently made by a senior health official in China, improvements in disease management and prevention have helped to transform infectious disease healthcare in China. However, there is still a considerable distance to go before China's healthcare system reaches western standards.
Death as a result of infectious diseases in China is reported to have fallen dramatically over the past 50 years, from being the leading cause of death in 1952 to being the tenth-leading cause in 2004.

Healthcare system fails to keep pace with economy

Over the last 25 years, China has undergone a remarkable evolution away from a state-powered economy towards a market-driven economy. As a result, by 2005 it reportedly overtook Britain's economy and was the leading international investment target. However, despite the country's rapidly improving economic situation, healthcare in China remains poor and infectious disease transmission continues to be a significant concern.

Hepatitis is a major health problem in China, which is home to one third of hepatitis B (HBV) patients and one quarter of hepatitis C (HCV) patients globally. Hepatitis is a particular problem in more rural areas, where the quality of healthcare is lower, a lower perceneforum.xxxe of the population can afford healthcare, and where the quality and availability of both vaccines and pharmaceutical treatment is low. There are also problems with the border regions; in terms of prostitution and drug use, which encourage the spread of infectious diseases.

Furthermore, migration from the borders and rural regions to eastern coastal regions is changing the dynamics of the epidemiology of hepatitis, particularly as birth rates decelerate in the more westernized regions.

Screening and prevention beginning to pay off

HBV and HCV screening, disease prevention programs aimed at increasing public awareness and improving health education, together with HBV vaccination, have all helped to reduce transmission in China. However, continued transmission from mother to child (for HBV) and transmission via blood transfusions and intravenous drug use (for HCV) means that both are likely to remain a problem.

Perinatal transmission at birth is the leading cause of HBV infection in Asia and in one Datamonitor study was shown to account for approximately one third of hepatitis B transmission. Meanwhile, the major HCV transmission route in Asia over the past few decades has been via administration of therapeutic blood products.

Research indicates that intravenous drug use accounts for a far smaller perceneforum.xxxe of HCV transmission than blood transfusions, which highlights the historically ineffective blood screening and blood transfusion equipment sterilization protocols in China. Cost containment remains a serious issue

The Datamonitor study found that - similar to the seven major markets - efficacy is the most important factor in HBV and HCV prescription in China. Reimbursement and cost was rated the second-most important factor. Interestingly, the side-effect profile ranked third in China, while this factor ranked second in the seven major markets; a factor likely related to the cost-conscious nature of the Chinese pharmaceutical market.

With per capita health expenditure in China at $49 in 2001, expenditure is estimated to be 1% of that spent in the US. Chinese healthcare was ranked 144th out of 191 countries by the World Health Organization (WHO) and it has been suggested that the healthcare system is one of the most unfair in the world. In fact, the Chinese Development Research Center recently stated that most of the medical needs of the Chinese society were unmet for economic reasons.

In addition to the low level of funding, there is a pervasive belief among Chinese hepatitis patients that expensive western pharmaceuticals are suboptimal in treating their condition. Indeed, there is some evidence that some therapies - such as interferons - are less effective in Asian patients.

Given that traditional Chinese medicines have been used for a lot longer to treat HBV and HCV, and they are positioned at a significantly lower price point relative to western pharmaceuticals, Chinese patients frequently choose these products over their western counterparts.

Another threat arising from Chinese patients' lack of desire to pay for expensive western pharmaceuticals comes in the shape of generic and counterfeit drugs. Counterfeit drugs are a particular problem and, in 2000, were thought to kill an estimated 200,000 people in China. Meanwhile, generic drugs may lack the efficacy and quality of branded pharmaceuticals.

There is substantial generic penetration of HBV and HCV drugs, with Chinese physicians indicating that up to half of the market is made up of generic drugs. There are suggestions that generic antivirals (e.g. lamivudine and adefovir) and generic immunomodulators such as unmodified interferons exist, however it is unlikely that generic pegylated interferons are on the market.

Given the complexity of manufacturing pegylated interferons, a possible strategy to counteract generic penetration would be to make it more difficult to manufacture a specific drug.

HBV prevalence set to fall

There are still significant issues for China to overcome in reducing the impact of hepatitis on society, but the picture is getting more promising, particularly for HBV. Raised disease awareness, increased focusing of scientific research, a wider availability of vaccines for neonates and improved economic conditions are all set to reduce HBV prevalence.

Meanwhile, although improved screening and risk management programs, along with greater wealth and better disease transmission prevention through sterilization, should help to reduce the prevalence of HCV in China, it is not set to fall over the short to medium term.

Mitigating factors such as intravenous drug use, illegal blood donation and transfusion, increased migration from rural areas and lack of a HCV vaccine will offset the advancements made in efficacy and infrastructure.

A range of disease prevention and management programs have been established in China and there are efficacious drugs available to treat these diseases. It is now up to the Chinese government to ensure a more rigorous implementation of these strategies. The government must also capitalize on the country's strong economy and its position as the leading investment target for the international community to boost healthcare spending and raise the quality of healthcare.

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