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. 2023 Mar 6;218(4):168-173.
doi: 10.5694/mja2.51825. Epub 2023 Jan 3.

The cost-effectiveness of universal hepatitis B screening for reaching WHO diagnosis targets in Australia by 2030

Yinzong Xiao  1 , Margaret E Hellard  1   2 , Alexander J Thompson  3   4 , Christopher Seaman  1   5 , Jess Howell  1   3 , Nick Scott  1   5
Affiliations

The cost-effectiveness of universal hepatitis B screening for reaching WHO diagnosis targets in Australia by 2030

Yinzong Xiao et al. Med J Aust. .

Abstract

Objectives: To assess the impact on diagnosis targets, cost, and cost-effectiveness of universal hepatitis B screening in Australia.

Design: Markov model simulation of disease and care cascade progression for people with chronic hepatitis B in Australia.

Setting: Three scenarios were compared: 1. no change to current hepatitis B virus (HBV) testing practice; 2. universal screening strategy, with the aim of achieving the WHO diagnosis target by 2030 (90% of people with chronic hepatitis B diagnosed), based on opportunistic (general practitioner-initiated) screening for HBsAg; 3. universal screening strategy, and also ensuring that 50% of people with chronic hepatitis B are receiving appropriate clinical management by 2030.

Main outcome measures: Projected care cascade for people with chronic hepatitis B, cumulative number of HBV-related deaths, intervention costs, and health utility (quality-adjusted life-years [QALYs] gained during 2020-2030). An incremental cost-effectiveness ratio (ICER) threshold (v scenario 1) of $50 000 per QALY gained was applied.

Results: Compared with scenario 1, 80 HBV-related deaths (interquartile range [IQR], 41-127 deaths) were averted during 2020-2030 in scenario 2, 315 HBV-related deaths (IQR, 211-454 deaths) in scenario 3. Scenario 2 cost $84 million (IQR, $41-106 million) more than scenario 1 during 2020-2030 (+8%), yielding an ICER of $104 921 (IQR, $49 587-107 952) per QALY gained. Scenario 3 cost $263 million (IQR, $214-316 million) more than scenario 1 during 2020-2030 (+24%), yielding an ICER of $47 341 (IQR, $32 643-58 200) per QALY gained. Scenario 3 remained cost-effective if the test positivity rate was higher than 0.35% or the additional costs per person tested did not exceed $4.02.

Conclusions: Universal screening for hepatitis B will be cost-effective only if the cost of testing is kept low and people receive appropriate clinical management.

Keywords: Economics, medical; Hepatitis B; Mass screening; Public health.

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References

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    1. World Health Organization. Global progress report on HIV, viral hepatitis and sexually transmitted infections, 2021. 15 July 2021. https://www.who.int/publications/i/item/9789240027077 (viewed July 2021).
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    1. Xiao Y, Howell J, van Gemert C, et al. Enhancing the hepatitis B care cascade in Australia: a cost-effectiveness model. J Viral Hepat 2020; 27: 526-536.

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