The Price of Life At this year’s Liver Congress, there was a consensus on long-acting interferon as a conventional drug for the treatment of hepatitis B. The consensus is that it is the most effective drug for the treatment of hepatitis B, and that it is the most cost-effective. The debate among experts centered on the prediction of the effectiveness of the treatment, and the definition of the scope of treatment. “Previously, the medical community believed that hepatitis B patients infected through the mother-to-child route did not respond very well to interferon, and early treatment consensus usually did not recommend interferon therapy for these patients.” Chen Crescent said, “But there are more and more cases proving that patients like Xiaohong can be cured by interferon, as long as you choose the right timing, method and course of treatment.” Indeed, most foreign experts now believe that only those patients who are younger, have lower blood viral DNA loads and higher transaminase levels are suitable for interferon therapy, as these indicators show that the patient has better autoimmune function and will respond better to interferon. Chen Xinyue mainly refers to these data when selecting patients, so the percentage of patients treated by her (combination of long-acting interferon + nucleoside analogs) with E-antigen conversion was 46% within one year, and 67% within two years, both figures are higher than the results of foreign clinical trials. Prof. Shanming Wu’s case is similar in that he also specializes in treating well-treated patients, so the percentage of his patients with E antigen conversion after 2 years of treatment is also above 60%. “I will always test my patients’ aminotransferase and surface antigen levels during treatment and will not blindly overmedicate.” Chen Crescent told the publication, “Take Xiaohong for example, she used to have elevated aminotransferases during the course of treatment, indicating that her immune system was working. And when her E antigen was converted, the surface antigen also dropped from the original 2,300 international units per milliliter to 91 international units per milliliter, indicating that her immune system was responding very well to interferon. It was because of this that I suggested she continue with the interferon to try to get the ‘gold medal’, which proved to be the right choice and was successful in the end.” “There have been more than one or two cases of patients like Xiao Hong who saw a significant decrease in surface antigen titer during consolidation therapy after E antigen conversion, and then prolonged the course of therapy and finally achieved surface antigen conversion.” Chen Crescent added. So how should Xiao Hong’s experience be generalized? Surface antigen titer in the end how much to reduce, in order to have a greater grasp of the “gold medal”? Such questions must be answered through rigorously designed clinical trials. However, Prof. Chen admitted that although he has been using combination therapy for hepatitis B since 2001, and has accumulated quite a number of successful cases in the past 8 years, they are all individualized cases, unlike the results of prospective, multi-center randomized controlled studies, which are more generalizable. Without rigorous clinical trials, it’s impossible to take treatment experience to a theoretical level and accurately make predictions about outcomes for each patient’s specific situation. “I once met a middle-aged male patient with ‘major triple yang’ who had completely normal liver function and was supposed to be in the immune tolerance period.” Chen Crescent told this reporter, “According to the criteria on the hepatitis B treatment guidelines, he was not suitable for treatment with interferon. However, this person is a businessman, the economic conditions are very good, coupled with his father and brother died of cirrhosis, liver cancer, hepatitis B is extremely fearful, insisting on long-acting interferon, spend as much money as possible to remove the hat of hepatitis B. In the end, it has been five years of Perotonin. In the end, he kept playing Pyroxin for 5 years and finally got the ‘gold medal’.” However, in Chen Crescent’s memory, cases like this are very rare. Even for selected patients, the percentage of those who finally get the “gold medal” is still relatively low. And most of the hepatitis B patients are not so good financial conditions, these people in the end should choose expensive long-acting interferon, or cheap ordinary interferon? At what stage of treatment can the drug be stopped? There is no clear answer to any of these questions, “Hepatitis B is a disease that requires very personalized treatment, and one size does not fit all.” However, the result is that hepatitis B patients can only take their chances, and if their own financial conditions are not good enough, or if they do not meet an experienced doctor, they will often take a lot of detours. “China is a big country for hepatitis B. Most Chinese doctors have very rich clinical experience, but they lack the systematic research tools to turn their experience into papers and summarize it into theories.” Bonino told this reporter, “Interferon is like an F1 car, it’s fast if you can drive it, but to drive it well, you have to master a special set of driving techniques beforehand, which requires a detailed and accurate driving manual.” We cannot wait for foreigners to write this manual. Hepatitis B has been effectively controlled in most of the developed world, and their scientists have devoted their main efforts to the treatment of Hepatitis C. The first step in the treatment of Hepatitis C was the introduction of long-acting interferon (LAI). In fact, long-acting interferon was originally developed for the treatment of hepatitis C. In addition, the physique of westerners is different from that of Chinese, and the subtypes of Hepatitis B virus prevalent in Europe and the United States are different from those in China, so China cannot completely copy the experience of foreign countries. Even the different healthcare systems in the East and West can have an impact on how hepatitis B is treated. “Italy has a very good health insurance system, not only is hepatitis B treatment free, even liver transplants are free.” Bonino describes, “Therefore, we think about where to spend our money most cost-effectively. I have suggested to the Italian Ministry of Health that young hepatitis B patients who have not yet developed the disease should be treated with interferon as early as possible, otherwise they will have to spend more money in the future when they get liver cancer and need a liver transplant.” Obviously, the situation in China is different from Italy. China has not yet included interferon in its health insurance, and patients have to pay for it out of their own pockets. For hepatitis B patients who are not financially well-off, there is a question of cost-effectiveness of different treatments. Should we use long-acting interferon or regular interferon? Is the difference in efficacy proportional to the difference in price? These questions require Chinese doctors to go through rigorous clinical trials to develop the most reasonable treatment for different situations. We have to admit that life has a price, especially for a chronic disease like Hepatitis B. The rich can choose the best treatment at any cost. While the rich can choose the best medicine at any cost, the poor have to live within their means and choose between life and money. The same is true from a national perspective. China is not a rich country and cannot guarantee that every patient will receive the best treatment, so it is all the more important to strengthen research in this area and develop the most cost-effective treatment programs as soon as possible. For this to happen, discrimination against hepatitis B patients must first be eliminated. It would be even more inappropriate if patients’ choices are influenced by some unfounded reasons.