The Cost-effectiveness of Screening for Chronic Hepatitis B Infection in the United States

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http://cid.oxfordjournals.org/content/52/11/1294.abstract?etoc

The Cost-effectiveness of Screening for Chronic Hepatitis B Infection in the

United States

Mark H. Eckman1,

E. Kaiser2, and

E. Sherman2

+ Author Affiliations

1Division of General Internal Medicine and the Center for Clinical Effectiveness

2Division of Digestive Diseases, University of Cincinnati, Ohio

Correspondence: Mark H. Eckman, MD, University of Cincinnati Medical Center, PO

Box 670535, Cincinnati, OH 45267-0535 (mark.eckman@...).

Abstract

(See the editorial commentary by Lo Re III, on pages 1307–1309.)

Background. Hepatitis B virus (HBV) continues to cause significant morbidity

and mortality in the United States. Current guidelines suggest screening

populations with a prevalence of ≥2%. Our objective was to determine whether

this screening threshold is cost-effective and whether screening

lower-prevalence populations might also be cost-effective.

Methods. We developed a Markov state transition model to examine screening of

asymptomatic outpatients in the United States. The base case was a 35-year-old

man living in a region with an HBV infection prevalence of 2%. Interventions

(versus no screening) included screening for Hepatitis B surface antigen

followed by treatment of appropriate patients with (1) pegylated interferon-α2a

for 48 weeks, (2) a low-cost nucleoside or nucleotide agent with a high rate of

developing viral resistance for 48 weeks, (3) prolonged treatment with low-cost,

high-resistance nucleoside or nucleotide, or (4) prolonged treatment with a

high-cost nucleoside or nucleotide with a low rate of developing viral

resistance. Effectiveness was measured in quality-adjusted life years (QALYs)

and costs in 2008 US dollars.

Results. Screening followed by treatment with a low-cost, high-resistance

nucleoside or nucleotide was cost-effective ($29,230 per QALY). Sensitivity

analyses revealed that screening costs <$50,000 per QALY in extremely low-risk

populations unless the prevalence of chronic HBV infection is <.3%.

Conclusions. The 2% threshold for prevalence of chronic HBV infection in

current Centers for Disease Control and Prevention/US Public Health Service

screening guidelines is cost-effective. Furthermore, screening of adults in the

United States in lower-prevalence populations (eg, as low as .3%) also is likely

to be cost-effective, suggesting that current health policy should be

reconsidered.

Received November 10, 2010.

Accepted February 2, 2011.

© The Author 2011. Published by Oxford University Press on behalf of the

Infectious Diseases Society of America. All rights reserved. For Permissions,

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