Cost-Effectiveness of Universal Screen-and-Treat Strategies for Reducing Morbidity and Mortality of Chronic Hepatitis B in a High-Endemicity City

Abstract

In the setting of high hepatitis B virus (HBV) endemicity, we studied the cost-effectiveness of universal HBV screen-and-treat strategies for averting HBV-related morbidity and mortality in Hong Kong, where diagnosis and treatment coverages are low. An age–sex-specific compartmental model for 2000–2040 was developed, with the incorporation of population-based screening strategies targeting different age groups. With a one-time HBV screening programme in 2025–2029, 3.6%–8.9% of HBV-related deaths could be averted. We evaluated the cost-effectiveness of the screening strategies with primary-care-based management in different scenarios with components of annual drug cost levels, screening programme duration, starting year and targeted age groups. Incremental cost-effectiveness ratio (ICER) was calculated, with the willingness-to-pay (WTP) threshold set at USD100,000/quality-adjusted life years (QALY). At the standard drug cost level, only the screening strategy targeting the 40–49 years old is cost-saving. When drug cost decreases to a low level, the strategy targeting the 35–49 years old (ICER USD97,042/QALY gained) is likely to be cost-effective and screening 35–59 years old is marginally cost-effective. In probabilistic sensitivity analysis, screening 40–49 years old (50%) and 35–59 years old (42%) have a half–half probability of being the most cost-effective at USD100,000/QALY WTP threshold, but increased to 93% for screening 35–59 years old at USD150,000/QALY threshold. From scenario analysis, deferred initiation of screening and unlimited programme duration would increase the ICER. Universal HBV screening targeting individuals aged 35–59 years or 40–49 years in the general population, with an earlier start and limited duration of the programme, is likely to be cost-effective.