Nguyen Ha Thi, Nguyen Phuong Thi Lan, Ngo Trinh Viet, Dang Anh Hoang Chau, Nguyen Huyen Thanh
University of Health Sciences, Vietnam National University Ho Chi Minh City, Di An City, Binh Duong Province, Vietnam.
Int J Clin Pharm. 2025 Sep 22. doi: 10.1007/s11096-025-02003-0.
Hepatitis B virus (HBV) causes significant morbidity and mortality worldwide, particularly in low- and middle-income countries (LMICs) with intermediate to high endemicity. Screening interventions are essential for reducing infection rates.
To synthesize economic evaluation evidence of hepatitis B (HBV) screening strategies in LMICs.
A comprehensive search of PubMed, Embase, and Scopus was conducted up to August 08, 2024. All types of economic evaluations comparing HBV screening strategies in LMICs were included. Study quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 and the Consensus Health Economic Criteria (CHEC) extended checklists. The protocol was registered in PROSPERO (CRD42023472855).
Twenty-four studies were included, with 11 focusing on pregnant women, 7 on adults, and others on children or infants. Most studies were from Asia, primarily China, using model-based analyses and a provider cost perspective. Regarding antenatal screening, adding tenofovir prophylaxis for HBsAg-positive pregnant women was more cost-effective than intervention solely targeting infants. In adults, a combination of screening and treating eligible cases or immunizing non-infected individuals was more cost-effective than no screening, particularly among young adults aged 21 to 39. Notably, expanding HBV screening to the general population was more cost-effective than limiting screening to high-risk groups. In children, screening plus re-vaccination of infants or 10-year-olds born to HBV-infected mothers was cost-effective compared to no re-vaccination.
Overall, more comprehensive interventions were generally cost-effective across all populations. The most cost-effective strategies included tenofovir prophylaxis for HBV-infected pregnant women, screening with treatment and/or vaccination in adults, and screening combined with re-vaccination in children.
乙型肝炎病毒（HBV）在全球范围内导致了严重的发病和死亡，尤其是在乙肝流行率处于中高水平的低收入和中等收入国家（LMICs）。筛查干预对于降低感染率至关重要。
综合低收入和中等收入国家乙肝（HBV）筛查策略的经济评估证据。
截至2024年8月8日，对PubMed、Embase和Scopus进行了全面检索。纳入了所有比较低收入和中等收入国家乙肝筛查策略的各类经济评估。使用2022年《卫生经济评估报告标准合并版》（CHEERS）和《卫生经济共识标准》（CHEC）扩展清单对研究质量进行评估。该方案已在国际前瞻性系统评价注册库（PROSPERO，注册号：CRD42023472855）中注册。
纳入了24项研究，其中11项关注孕妇，7项关注成年人，其他关注儿童或婴儿。大多数研究来自亚洲，主要是中国，采用基于模型的分析方法并从提供者成本角度进行研究。关于产前筛查，对乙肝表面抗原（HBsAg）阳性孕妇加用替诺福韦预防比仅针对婴儿的干预措施更具成本效益。在成年人中，对符合条件的病例进行筛查和治疗或对未感染个体进行免疫接种的联合方案比不进行筛查更具成本效益，特别是在21至39岁的年轻人中。值得注意的是，将乙肝病毒筛查扩展到普通人群比将筛查局限于高危人群更具成本效益。在儿童中，与不进行再接种相比，对乙肝病毒感染母亲所生的婴儿或10岁儿童进行筛查并重新接种疫苗具有成本效益。
总体而言，更全面的干预措施在所有人群中通常都具有成本效益。最具成本效益的策略包括对乙肝病毒感染孕妇采用替诺福韦预防，对成年人进行筛查并结合治疗和/或接种疫苗，以及对儿童进行筛查并结合重新接种疫苗。
