Cost effectiveness of screening immigrants for hepatitis B

[Guest guest]

http://onlinelibrary.wiley.com/doi/10.1111/j.1478-3231.2011.02559.x/abstract

Cost effectiveness of screening immigrants for hepatitis B

W. L. Wong1,2, Gloria Woo1,2, E. Heathcote3,4, Murray Krahn1,2,3,4

Article first published online: 14 JUN 2011

DOI: 10.1111/j.1478-3231.2011.02559.x

© 2011 Wiley & Sons A/S

Issue

Liver International

Volume 31, Issue 8, pages 1179–1190, September 2011

Abstract

Background: The prevalence of chronic hepatitis B (CHB) infection among the

immigrants of North America ranges from 2 to 15%, among whom 40% develop

advanced liver disease. Screening for hepatitis B surface antigen is not

recommended for immigrants.

Aims: The objective of this study is to estimate the health and economic effects

of screening strategies for CHB among immigrants.

Methods: We used the Markov model to examine the cost-effectiveness of three

screening strategies: (i) ‘No screening’; (ii) ‘Screen and Treat’ and (iii)

‘Screen, Treat and Vaccinate’ for 20–65 years old individuals who were born

abroad but are currently living in Canada. Model data were obtained from the

published literature. We measured predicted hepatitis B virus (HBV)-related

deaths, costs (2008 Canadian Dollars), quality-adjusted life-years (QALYs), and

incremental cost-effectiveness ratio (ICER).

Results: Our results show that screening all immigrants will prevent 59

HBV-related deaths per 10 000 persons screened over the lifetime of the cohort.

Screening was associated with an increase in quality-adjusted life expectancy

(0.024 QALYs) and cost ($1665) per person with an ICER of $69 209/QALY gained

compared with ‘No screening’. The ‘Screen, Treat and Vaccinate’ costs an

additional $81, generates an additional 0.000022 QALYs per person, with an ICER

of $3 648 123/QALY compared with the ‘Screen and Treat’. Sensitivity analyses

suggested that the ‘Screen and Treat’ is likely to be moderately cost-effective.

Conclusion: We show that a selective hepatitis B screening programme targeted at

all immigrants in Canada is likely to be moderately cost-effective.

Identification of silent CHB infection with the offer of treatment when

appropriate can extend the lives of immigrants at reasonable cost.