Screening and Early Treatment of Migrants for Chronic Hepatitis B Virus Infection Is Cost-Effective

Background & Aims

Persons with chronic hepatitis B virus (HBV) infection are at risk of developing cirrhosis and hepatocellular carcinoma. Early detection of chronic HBV infection through screening and treatment of eligible patients has the potential to prevent these sequelae. We assessed the cost-effectiveness in The Netherlands of systematically screening migrants from countries that have high and intermediate HBV infection levels.

Methods

Epidemiologic data of the expected numbers of patients with active chronic HBV infection in the target population and information about the costs of a screening program were used in a Markov model and used to determine costs and quality-adjusted life years (QALY) for patients who were and were not treated.

Results

Compared with the status quo, a 1-time screen for HBV infection can reduce mortality of liver-related diseases by 10%. Using base case estimates, the incremental cost-effectiveness ratio (ICER) of screening, compared with not screening, is euros (€) 8966 per QALY gained. The ICER ranged from €7936 to €11,705 based on univariate sensitivity analysis, varying parameter values of HBV prevalence, participation rate, success in referral, and treatment compliance. Using multivariate sensitivity analysis for treatment effectiveness, the ICER ranged from €7222 to €15,694; for disease progression, it ranged from €5568 to €60,418.

Conclusions

Early detection and treatment of people with HBV infection can have a large impact on liver-related health outcomes. Systematic screening for chronic HBV infection among migrants is likely to be cost-effective, even using low estimates for HBV prevalence, participation, referral, and treatment compliance.

Abbreviations used in this paper: CHB, chronic hepatitis B, GP, general practitioner, ICER, incremental cost-effectiveness ratio, MPHS, Municipal Public Health Service, QALYs, quality-adjusted life-years