Asian Liver Center, Department of Surgery, Stanford University School of Medicine, Palo Alto, California, USA.
Department of Health Management and Policy, University of Michigan, Ann Harbor, Michigan, USA.
Clin Infect Dis. 2022 Jan 29;74(2):210-217. doi: 10.1093/cid/ciab405.
An estimated 862 000 to 2.4 million people have chronic hepatitis B infection (CHB). Hepatitis B screening is recommended for pregnant women and populations with increased CHB risk. However, diagnosis rates remain low, with only 33% of people with CHB aware of their infection. This study aimed to assess the cost-effectiveness of universal adult screening for CHB.
We used a Markov model to calculate the costs, population health impact, and cost-effectiveness of 1-time universal screening and CHB monitoring and treatment compared with current practice. Sensitivity analysis was performed on model parameters to identify thresholds for cost-saving or cost-effectiveness based on a willingness to pay of $50 000/quality-adjusted life-year. The analysis assumed testing would be performed during routine healthcare visits and that generic tenofovir or entecavir would be dispensed for treatment. Testing costs were based on Medicare reimbursement rates.
At an estimated 0.24% prevalence of undiagnosed CHB, universal hepatitis B surface antigen (HBsAg) screening in adults aged 18-69 years is cost-saving compared with current practice if antiviral treatment drug costs remain below $894/year. Compared with current practice, universal screening would avert an additional 7.4 cases of compensated cirrhosis, 3.3 cases of decompensated cirrhosis, 5.5 cases of hepatocellular carcinoma, 1.9 liver transplants, and 10.3 hepatitis B virus-related deaths at a saving of $263 000/100 000 adults screened.
Universal HBsAg screening of adults in the US general population for CHB is cost-effective and likely cost-saving compared with current CHB screening recommendations.
据估计，有 86.2 万至 240 万人患有慢性乙型肝炎（CHB）。建议对孕妇和乙型肝炎感染风险增加的人群进行乙型肝炎筛查。然而，诊断率仍然很低，只有 33%的乙型肝炎患者知道自己感染了乙型肝炎。本研究旨在评估对普通成人进行乙型肝炎普查的成本效益。
我们使用马尔可夫模型来计算一次性普遍筛查和乙型肝炎监测与治疗与现行做法相比的成本、人群健康影响和成本效益。对模型参数进行了敏感性分析，以确定基于 50000 美元/质量调整生命年的支付意愿，成本节约或成本效益的阈值。该分析假设测试将在常规医疗保健就诊期间进行，并且将为治疗开出处方用替诺福韦或恩替卡韦。测试成本基于医疗保险报销率。
在估计为 0.24%的未确诊 CHB 患病率的情况下，如果抗病毒治疗药物成本保持在每年 894 美元以下，那么在 18-69 岁成年人中进行普遍乙型肝炎表面抗原（HBsAg）筛查比现行做法具有成本效益。与现行做法相比，普遍筛查可额外避免 7.4 例代偿性肝硬化、3.3 例失代偿性肝硬化、5.5 例肝细胞癌、1.9 例肝移植和 10.3 例乙型肝炎病毒相关死亡，每 10 万筛查的成年人可节省 26.3 万美元。
与现行的乙型肝炎筛查建议相比，对美国普通人群进行普遍 HBsAg 筛查来筛查 CHB 具有成本效益，而且可能具有成本节约效果。
