Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
PLoS One. 2018 Nov 8;13(11):e0207037. doi: 10.1371/journal.pone.0207037. eCollection 2018.
Chronic infection with hepatitis B or C virus (HBV/HCV) can progress to cirrhosis, liver cancer, and even death. In a low endemic country as the Netherlands, migrants are a key risk group and could benefit from early diagnosis and antiviral treatment. We assessed the cost-effectiveness of screening foreign-born migrants for chronic HBV and/or HCV using a societal perspective.
The cost-effectiveness was evaluated using a Markov model. Estimates on prevalence, screening programme costs, participation and treatment uptake, transition probabilities, healthcare costs, productivity losses and utilities were derived from the literature. The cost per Quality Adjusted Life Year (QALY) gained was estimated and sensitivity analyses were performed.
For most migrant groups with an expected high number of chronically infected cases in the Netherlands combined screening is cost-effective, with incremental cost-effectiveness ratios (ICERs) ranging from €4,962/QALY gained for migrants originating from the Former Soviet Union and Vietnam to €9,375/QALY gained for Polish migrants. HBV and HCV screening proved to be cost-effective for migrants from countries with chronic HBV or HCV prevalence of ≥0.41% and ≥0.22%, with ICERs below the Dutch cost-effectiveness reference value of €20,000/QALY gained. Sensitivity analysis showed that treatment costs influenced the ICER for both infections.
For most migrant populations in a low-endemic country offering combined HBV and HCV screening is cost-effective. Implementation of targeted HBV and HCV screening programmes to increase early diagnosis and treatment is important to reduce the burden of chronic hepatitis B and C among migrants.
慢性乙型肝炎或丙型肝炎病毒（HBV/HCV）感染可进展为肝硬化、肝癌，甚至死亡。在像荷兰这样低流行国家，移民是一个关键的风险群体，可以从早期诊断和抗病毒治疗中受益。我们从社会角度评估了对外国出生的移民进行慢性乙型肝炎和/或丙型肝炎筛查的成本效益。
使用马尔可夫模型评估成本效益。患病率、筛查计划成本、参与和治疗率、转移概率、医疗保健成本、生产力损失和效用的估计值来自文献。每获得一个质量调整生命年（QALY）的成本进行了估计，并进行了敏感性分析。
对于预计在荷兰有大量慢性感染病例的大多数移民群体，联合筛查具有成本效益，增量成本效益比（ICER）范围从来自前苏联和越南的移民的 4962 欧元/QALY 增加到波兰移民的 9375 欧元/QALY。HBV 和 HCV 筛查对于来自慢性 HBV 或 HCV 流行率≥0.41%和≥0.22%的国家的移民是具有成本效益的，ICER 低于荷兰 20000 欧元/QALY 的成本效益参考值。敏感性分析表明，治疗成本对两种感染的 ICER 都有影响。
在低流行国家，对于大多数移民群体来说，联合进行 HBV 和 HCV 筛查具有成本效益。实施有针对性的 HBV 和 HCV 筛查计划，以提高早期诊断和治疗水平，对于减少移民中慢性乙型肝炎和丙型肝炎的负担非常重要。
