Cost-Effectiveness of Interventions to Improve Retention in Care for Chronic Hepatitis B in the United States

Abstract

Monitoring and retention in care remain suboptimal for patients diagnosed with chronic hepatitis B (CHB) infection with only a minority receiving consistent follow-up. This study evaluates the cost-effectiveness of interventions aimed at improving long-term monitoring and retention in care among diagnosed CHB. A Markov model simulated outcomes for a cohort of 100,000 adults, comparing current practice to three interventions: EHR-based provider reminders, patient navigators and a combined strategy. Costs and quality-adjusted life years (QALYs) were evaluated from a healthcare perspective. All interventions were cost-effective, with weighted incremental cost-effectiveness ratios (US$/QALY) of US$8069 (EHR reminders), US$8416 (Patient Navigators) and US$8608 (Combined). Compared with current practice, a combined strategy would avert 1670 cases of compensated cirrhosis, 738 cases of decompensated cirrhosis, 1011 cases of hepatocellular carcinoma, 188 liver transplants, and 2058 CHB-related deaths in a cohort of 100,000. Structured interventions to improve CHB monitoring can deliver substantial health gains at modest costs. These findings can support policy initiatives to improve CHB care retention and highlight the importance of tailoring interventions to local healthcare capacity and population needs.