Return to Toolbox Main.

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

Keywords / Description:

Background. Hepatitis B virus (HBV) continues to cause significant morbidity and mortality in the United States. Current guidelines suggest screening populations with a prevalence ofR2%. 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 symptomatic 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-a2a 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 costeffective ($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.

Toolkit:

Infectious Disease Prevention and Control Toolkit

Keyword Area:

HIV/AIDS, Infectious Diseases

Jurisdiction:

Institutional Author:

National AIDS treatment Advocacy Project

Submitted:

04/26/2012

Modified:

04/30/2012

The NACCHO Toolbox is a repository of available resources to help local public health practitioners. Tools are produced by local, state, and federal agencies, as well as academic institutions and other stakeholders. The contents of this Toolbox are solely the responsibility of the authors and do not necessarily reflect any official recommendations of NACCHO. NACCHO makes no express or implied warranty with respect to the contents and disclaims liability for any damages arising from or connected to the use of the material in this Toolbox.