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

Early View (Online Version of Record published before inclusion in an issue)

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.

[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

Early View (Online Version of Record published before inclusion in an issue)

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.