Cost-effectiveness of screening for chronic hepatitis B and C among migrant populations in a low endemic country

Abstract

Background: Chronic infection with hepatitis B or C virus (HBV/HCV) can progress to cirrhosis, liver cancer, and even death. In a low endemic country as the Netherlands, migrants are a key risk group and could benefit from early diagnosis and antiviral treatment. We assessed the cost-effectiveness of screening foreign-born migrants for chronic HBV and/or HCV using a societal perspective.

Methods: The cost-effectiveness was evaluated using a Markov model. Estimates on prevalence, screening programme costs, participation and treatment uptake, transition probabilities, healthcare costs, productivity losses and utilities were derived from the literature. The cost per Quality Adjusted Life Year (QALY) gained was estimated and sensitivity analyses were performed.

Results: For most migrant groups with an expected high number of chronically infected cases in the Netherlands combined screening is cost-effective, with incremental cost-effectiveness ratios (ICERs) ranging from €4,962/QALY gained for migrants originating from the Former Soviet Union and Vietnam to €9,375/QALY gained for Polish migrants. HBV and HCV screening proved to be cost-effective for migrants from countries with chronic HBV or HCV prevalence of ≥0.41% and ≥0.22%, with ICERs below the Dutch cost-effectiveness reference value of €20,000/QALY gained. Sensitivity analysis showed that treatment costs influenced the ICER for both infections.

Conclusions: For most migrant populations in a low-endemic country offering combined HBV and HCV screening is cost-effective. Implementation of targeted HBV and HCV screening programmes to increase early diagnosis and treatment is important to reduce the burden of chronic hepatitis B and C among migrants.

Fig 1. Maximum investment (€2016) allowed per migrant to achieve cost-effective combined HBV/HCV screening (results for migrants from the Former Soviet Union and born before 1991, Former Yugoslavia, born before 1991, and Former Dutch Antilles, born before 2010, are not included in this graph).

Fig 2. Sensitivity analysis for 10 most important HBV input parameters when decreasing and increasing them with 25% for Turkey, baseline ICER: €6233/QALY.

Fig 3. Sensitivity analysis for 10 most important HBV input parameters when decreasing and increasing them with 25% for Surinam, baseline ICER: €5803/QALY.