PLoS ONE
Volume 13, Issue 11, 2018

Cost-effectiveness of screening for chronic hepatitis B and C among migrant populations in a low endemic country (Article) (Open Access)

Suijkerbuijk A.W.M.* , Van Hoek A.J. , Koopsen J. , De Man R.A. , Mangen M.-J.J. , De Melker H.E. , Polder J.J. , De Wit G.A. , Veldhuijzen I.K.
  • a Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
  • b Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
  • c Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
  • d Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, Netherlands
  • e Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
  • f Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
  • g Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands, Tranzo Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
  • h Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands, Julius Centre for Health Sciences and Primary Health Care, University Medical Centre Utrecht, Utrecht, Netherlands
  • i Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands

Abstract

Background Chronic infection with hepatitis B or C virus (HBV/HCV) can progress to cirrhosis, liver cancer, and even death. In a low endemic country as the Netherlands, migrants are a key risk group and could benefit from early diagnosis and antiviral treatment. We assessed the cost-effectiveness of screening foreign-born migrants for chronic HBV and/or HCV using a societal perspective. Methods The cost-effectiveness was evaluated using a Markov model. Estimates on prevalence, screening programme costs, participation and treatment uptake, transition probabilities, healthcare costs, productivity losses and utilities were derived from the literature. The cost per Quality Adjusted Life Year (QALY) gained was estimated and sensitivity analyses were performed. Results For most migrant groups with an expected high number of chronically infected cases in the Netherlands combined screening is cost-effective, with incremental cost-effectiveness ratios (ICERs) ranging from €4,962/QALY gained for migrants originating from the Former Soviet Union and Vietnam to €9,375/QALY gained for Polish migrants. HBV and HCV screening proved to be cost-effective for migrants from countries with chronic HBV or HCV prevalence of 0.41% and 0.22%, with ICERs below the Dutch cost-effectiveness reference value of €20,000/QALY gained. Sensitivity analysis showed that treatment costs influenced the ICER for both infections. Conclusions For most migrant populations in a low-endemic country offering combined HBV and HCV screening is cost-effective. Implementation of targeted HBV and HCV screening programmes to increase early diagnosis and treatment is important to reduce the burden of chronic hepatitis B and C among migrants. © 2018 Suijkerbuijk et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Author Keywords

[No Keywords available]

Index Keywords

Netherlands Markov Chains Cost benefit analysis mass screening economics human statistics and numerical data chronic hepatitis C geographic distribution USSR sensitivity analysis Hepatitis C, Chronic nonhuman quality adjusted life year intermethod comparison Quality-Adjusted Life Years Humans migrant Emigrants and Immigrants Viet Nam hidden Markov model prevalence Article Hepatitis B, Chronic chronic hepatitis B disease burden cost-benefit analysis Markov chain early diagnosis mortality reference value program cost effectiveness
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85056422037&doi=10.1371%2fjournal.pone.0207037&partnerID=40&md5=974b19a5e4655c39dad268d877e179e0
DOI: 10.1371/journal.pone.0207037
ISSN: 19326203
Cited by: 2
Original Language: English