Screening and early treatment of migrants for chronic hep B is cost-effective

Screening and early treatment of migrants for chronic hepatitis B virus infection is cost-effective, finds this month's issue of Gastroenterology.

Persons with chronic hepatitis B virus infection are at risk of developing cirrhosis and hepatocellular carcinoma.
 
Early detection of chronic hepatitis B virus infection through screening and treatment of eligible patients has the potential to prevent these sequelae.

Dr Irene Veldhuijzen and colleagues from the Netherlands assessed the cost-effectiveness of systematically screening migrants from countries that have high and intermediate hepatitis B virus infection levels.

Epidemiologic data of the expected numbers of patients with active chronic hepatitis B virus infection in the target population and information about the costs of a screening program were used in a Markov model.

Incremental cost-effectiveness ratios of screening ranged from €7222 to €15,694

Gastroenterology

The research team used this data to determine costs and quality-adjusted life years for patients who were and were not treated.

Compared with the status quo, a 1-time screen for hepatitis B virus infection can reduce mortality of liver-related diseases by 10%.

Using base case estimates, the incremental cost-effectiveness ratio of screening, compared with not screening, is euros (€) 8966 per quality of life gained.

The team noted that the incremental cost-effectiveness ratio of screening ranged from €7936 to €11,705.

This was based on univariate sensitivity analysis, varying parameter values of hepatitis B virus prevalence, participation rate, success in referral, and treatment compliance.

Using multivariate sensitivity analysis for treatment effectiveness, the incremental cost-effectiveness ratio of screening ranged from €7222 to €15,694, and for disease progression, it ranged from €5568 to €60,418.

Dr Veldhuijzen's team concludes, "Early detection and treatment of people with hepatitis B virus infection can have a large impact on liver-related health outcomes."

"Systematic screening for chronic hepatitis B virus infection among migrants is likely to be cost-effective, even using low estimates for hepatitis B virus prevalence, participation, referral, and treatment compliance."