BACKGROUND: The prevalence of chronic hepatitis B (CHB) infection among the immigrants of North America ranges from 2 to 15%, among whom 40% develop advanced liver disease. Screening for hepatitis B surface antigen is not recommended for immigrants. AIMS: The objective of this study is to estimate the health and economic effects of screening strategies for CHB among immigrants. METHODS: We used the Markov model to examine the cost-effectiveness of three screening strategies: (i) 'No screening'; (ii) 'Screen and Treat' and (iii) 'Screen, Treat and Vaccinate' for 20-65 years old individuals who were born abroad but are currently living in Canada. Model data were obtained from the published literature. We measured predicted hepatitis B virus (HBV)-related deaths, costs (2008 Canadian Dollars), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER). RESULTS: Our results show that screening all immigrants will prevent 59 HBV-related deaths per 10, 000 persons screened over the lifetime of the cohort. Screening was associated with an increase in quality-adjusted life expectancy (0.024 QALYs) and cost ($1665) per person with an ICER of $69, 209/QALY gained compared with 'No screening'. The 'Screen, Treat and Vaccinate' costs an additional $81, generates an additional 0.000022 QALYs per person, with an ICER of $3, 648,123/QALY compared with the 'Screen and Treat'. Sensitivity analyses suggested that the 'Screen and Treat' is likely to be moderately cost-effective. CONCLUSION: We show that a selective hepatitis B screening programme targeted at all immigrants in Canada is likely to be moderately cost-effective. Identification of silent CHB infection with the offer of treatment when appropriate can extend the lives of immigrants at reasonable cost.
BACKGROUND: The prevalence of chronic hepatitis B (CHB) infection among the immigrants of North America ranges from 2 to 15%, among whom 40% develop advanced liver disease. Screening for hepatitis B surface antigen is not recommended for immigrants. AIMS: The objective of this study is to estimate the health and economic effects of screening strategies for CHB among immigrants. METHODS: We used the Markov model to examine the cost-effectiveness of three screening strategies: (i) 'No screening'; (ii) 'Screen and Treat' and (iii) 'Screen, Treat and Vaccinate' for 20-65 years old individuals who were born abroad but are currently living in Canada. Model data were obtained from the published literature. We measured predicted hepatitis B virus (HBV)-related deaths, costs (2008 Canadian Dollars), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER). RESULTS: Our results show that screening all immigrants will prevent 59 HBV-related deaths per 10, 000 persons screened over the lifetime of the cohort. Screening was associated with an increase in quality-adjusted life expectancy (0.024 QALYs) and cost ($1665) per person with an ICER of $69, 209/QALY gained compared with 'No screening'. The 'Screen, Treat and Vaccinate' costs an additional $81, generates an additional 0.000022 QALYs per person, with an ICER of $3, 648,123/QALY compared with the 'Screen and Treat'. Sensitivity analyses suggested that the 'Screen and Treat' is likely to be moderately cost-effective. CONCLUSION: We show that a selective hepatitis B screening programme targeted at all immigrants in Canada is likely to be moderately cost-effective. Identification of silent CHB infection with the offer of treatment when appropriate can extend the lives of immigrants at reasonable cost.
Authors: Aaron M Harris; Ben T Schoenbachler; Gilberto Ramirez; Claudia Vellozzi; Geoff A Beckett Journal: Public Health Rep Date: 2016 May-Jun Impact factor: 2.792
Authors: Henry Pollack; Su Wang; Laura Wyatt; Chia-Hui Peng; Kejia Wan; Chau Trinh-Shevrin; Kay Chun; Thomas Tsang; Simona Kwon Journal: Health Aff (Millwood) Date: 2011-10 Impact factor: 6.301
Authors: C Schnier; L Wallace; K Tempelton; C Aitken; R N Gunson; P Molyneaux; P McINTYRE; C Povey; D Goldberg; S Hutchinson Journal: Epidemiol Infect Date: 2013-12-17 Impact factor: 4.434
Authors: Carmine Rossi; Ian Shrier; Lee Marshall; Sonya Cnossen; Kevin Schwartzman; Marina B Klein; Guido Schwarzer; Chris Greenaway Journal: PLoS One Date: 2012-09-05 Impact factor: 3.240