Wang Lei, Zheng Hui, Xia Lanfang, Zhang Guomin, Wang Fuzhen, Yin Zundong, Wang Huaqing
National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases (NITFID), National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China.
China CDC Wkly. 2025 Apr 25;7(17):586-591. doi: 10.46234/ccdcw2025.096.
Eliminating hepatitis B virus (HBV) as a major public health threat is a global health priority that requires cost-effective screening strategies. This study evaluated the cost-effectiveness of sequential birth cohort HBV screening strategies in China.
Using a Markov model, we compared five screening strategies with current practice, calculating HBV-related deaths averted, quality-adjusted life years (QALYs) gained, and incremental cost-effectiveness ratios (ICER). One-way deterministic and probabilistic sensitivity analyses were conducted to evaluate the robustness of the results.
The sequential birth cohort screening strategy (Sequential Screening 1: screening the 1991-2000 cohort in 2025-2026, the 1971-1990 cohort in 2027-2028, and the 1951-1970 cohort in 2029-2030) was the most cost-effective, with an ICER of 58,523 Chinese Yuan (CNY) per QALY at a willingness-to-pay threshold of three times the per-capita Gross Domestic Product (GDP). An alternative strategy that prioritized the 1951-1970 cohort in 2025-2026 averted the most HBV-related deaths (approximately 3.44 million) and gained 24.9 million QALYs, with an ICER of 60,113 CNY per QALY, also showing cost-effectiveness.
Our findings support sequential birth cohort screening as an optimal and innovative approach to achieving the WHO HBV elimination targets, offering evidence-informed guidance for policymakers to optimize screening programs and resource allocation.
消除乙型肝炎病毒（HBV）这一重大公共卫生威胁是一项全球卫生重点工作，需要具备成本效益的筛查策略。本研究评估了中国按出生队列顺序进行HBV筛查策略的成本效益。
我们使用马尔可夫模型，将五种筛查策略与当前做法进行比较，计算避免的HBV相关死亡人数、获得的质量调整生命年（QALY）以及增量成本效益比（ICER）。进行了单向确定性和概率敏感性分析，以评估结果的稳健性。
按出生队列顺序进行筛查的策略（顺序筛查1：在2025 - 2026年筛查1991 - 2000年出生队列，在2027 - 2028年筛查1971 - 1990年出生队列，在2029 - 2030年筛查1951 - 1970年出生队列）是最具成本效益的，在支付意愿阈值为人均国内生产总值（GDP）三倍的情况下，每QALY的ICER为58,523元人民币（CNY）。另一种在2025 - 2026年优先筛查1951 - 1970年出生队列的策略避免了最多的HBV相关死亡（约344万），并获得了2490万个QALY，每QALY的ICER为60,113元人民币，也显示出成本效益。
我们的研究结果支持按出生队列顺序进行筛查，这是实现世界卫生组织HBV消除目标的一种最佳且创新的方法，为政策制定者优化筛查计划和资源分配提供了基于证据的指导。
