Universal Population Hepatitis B Screening Amongst Adults In China Is Cost-effective: A Cost-effective Analysis.

Abstract

Background: China has the largest disease burdens of hepatitis B virus (HBV) infection worldwide, accounting for one-third of the world's infected population. Universal population-based screening of HBV infection among Chinese adults may be useful to identify undocumented HBV cases for further follow-ups, linkage-to-care and management, and in meeting the World Health Organization target of eliminating HBV as a public health threat by 2030. We aimed to evaluate the cost-effectiveness of universal population screening for HBV using a Markov decision-tree model. Methods: We constructed four screening strategies based on (1) HBsAg rapid test; (2) combined HBsAg/HBsAb test; (3) combined HBsAg/HBsAb/HBcAb test and (4) HBsAg/HBsAb/HBeAg/HBeAb/HBcAb test, the latter being most commonly used in China. Diagnosed individuals would receive further HBV monitoring and, when appropriate, antiviral therapy in primary and secondary care in China. We collected data from the public domains on epidemiological, primary screening, cost and life quality parameters. The outcome measures included cost per quality-adjusted life-year (QALY) gained and cost per life-year saved. We estimated the incremental cost-effectiveness ratios (ICERs) by comparing the current practice and the proposed screening strategies. Costs were assessed from a health provider perspective. Costs and health outcomes were discounted at 3% per year. Results: In China, the current population prevalence of HBsAg was 1.4%, 4.0%, 5.9% and 7.3% in individuals aged 18, 30, 40, 50 years old, respectively. Based on the cost of per QALY gained, all screening strategies were non-dominated compared with the status quo. According to the China willingness-to-pay levels ($30,382) in 2019 (three times the country's gross domestic product per capita, $10,127, 1 USD = 7 RMB), the combined HBsAg/HBsAb/HBcAb test was cost-effective at all agee but was most cost-effective at age 50 ($14,322 per QALY gained) and age 18 ($27,933 per QALY gained). In comparison, the combined HBsAg/HBsAb/HBeAg/HBeAb/HBcAb test was optimal for population-based screening started at age 30 and 40 years (ICER = $21,276 and $19,343/QALY gained, respectively). When considering life-years saved, HBV rapid test was cost-effective among at all ages but optimal at 40 and 50 years ($315 and $284 per life-year saved). Combined HBsAg/HBsAb/HBeAg/HBeAb/HBcAb test was the most cost-effective for populations aged 18 and 30 years ($25,982 and $14,353 per life-year saved). Conclusion: Universal population-based screening for HBV for Chinese adults is likely to be cost-effective in China. Mass HBV screening can play a pivotal role in improving diagnostic coverage of HBV and in achieving the WHO objectives of eliminating HBV as a public health threat.