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Strategy of screening for HBV, then treating or vaccinating is cost-effective

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January 9, 2019

An “inclusive” strategy of screening patients for hepatitis B virus infection or susceptibility and then treating or vaccinating them appropriately is the most cost-effective intervention strategy for high-risk, high-prevalence populations, according to study findings.

“In 2013, [chronic hepatitis B] was a leading cause of mortality with 686,000 deaths. In the United States, as many as 2 million may be chronically infected with HBV, primarily foreign-born persons from high prevalence countries and those at high behavioral risk (cohabitating with an HBV carrier or engaging in injection drug use or unprotected sex with multiple or infected partners),” Harinder Singh Chahal, PharmD, MSc, assistant adjunct professor of microbiology and immunology in the department of clinical pharmacy at the University of California, San Francisco, and colleagues wrote.

According to the authors, research has shown that chronic hepatitis B prevalence is 5% to 10% in foreign-born Asian/Pacific Islanders and Africa-born blacks, 1% to 4% among incarcerated persons, 3.5% to 20% among people who inject drugs, 1% to 3% in men who have sex with men (MSM), and 6% in refugees.

“Most people with [chronic hepatitis B] are unaware of their infection with HBV,” the authors wrote. “The [CDC] has identified core measures to reduce HBV burden in the U.S., including improving testing, vaccination and treatment.”

Previous economic analyses have shown screening programs for vaccination or treatment to be cost-effective, however, no past analyses have looked across populations and intervention options, according to the researchers. For their study, Chahal and colleagues conducted a health and economic analysis of three strategies: screen for HBV infection and treat, screen for HBV susceptibility and vaccinate, and screen then treat or vaccinate as appropriate. They estimated the cost, quality-adjusted life years (QALYs), cost effectiveness and clinical impact of each.

Results of the study showed that treatment-only and vaccination-only strategies had incremental cost-effectiveness ratios of $6,000 to $21,000 per QALY gained.

According to Chahal and colleagues, the third “inclusive” strategy added minimal cost per QALY: $3,203 for incarcerated populations; $8,514 for people who inject drugs; $10,954 for MSM, $17,089 for Africa-born blacks; $17,432 for refugees and $18,009 for foreign-born Asian/Pacific Islanders. The strategy also had substantial clinical benefit, they reported.

“Our cost-effectiveness analysis found that inclusive HBV screen and vaccinate or treat strategies cost $3,000 to $18,000 dollars per quality-adjusted life year gained, compared with no intervention,” the authors concluded. “Although isolated screen for immunity-and-vaccinate or screen for infection-and-treat strategies are also cost-effective, the broadening to an inclusive approach was incrementally very cost-effective or even cost-saving. These findings were qualitatively consistent across the modeled populations and a range of input values.” – by Caitlyn Stulpin

Disclosures: Chahal reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.


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Chari Cohen, MPH

Risk-based screening for hepatitis B, followed by appropriate follow-up (vaccination for those susceptible or linkage to care for those infected), is critical to reducing illness and death associated with chronic hepatitis B infection. Currently, only 25% of infected individuals in the U.S. are diagnosed and 10% access medical care. Implemented comprehensively, the “inclusive” strategy discussed in the Chahal et al article would be cost-effective and lead to reduced hepatitis B disease burden among highly impacted communities. However, there are significant barriers to a scaled-up implementation of this approach, including severely limited funding and resources, and low hepatitis B knowledge and awareness among providers and high-risk communities. We need to increase prioritization of hepatitis B as an important public health concern in the U.S. if we want to identify, manage, treat, and protect more individuals — and save more lives.

Chari Cohen, DrPH, MPH

Vice president, public health and programs
Hepatitis B Foundation

Disclosure: Cohen reports no relevant financial disclosures.