Gastroenterology
Volume 138, Issue 2, 2010, Pages 522-530

Screening and Early Treatment of Migrants for Chronic Hepatitis B Virus Infection Is Cost-Effective (Article)

Veldhuijzen I.K.* , Toy M. , Hahné S.J.M. , De Wit G.A. , Schalm S.W. , de Man R.A. , Richardus J.H.
  • a Division of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, Netherlands, Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
  • b Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands, LiverDoc, Rotterdam, Netherlands
  • c National Institute of Public Health and the Environment (RIVM), Bilthoven, Netherlands
  • d National Institute of Public Health and the Environment (RIVM), Bilthoven, Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, Netherlands
  • e Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands, LiverDoc, Rotterdam, Netherlands
  • f Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
  • g Division of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, Netherlands, Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands

Abstract

Background & Aims: Persons with chronic hepatitis B virus (HBV) infection are at risk of developing cirrhosis and hepatocellular carcinoma. Early detection of chronic HBV infection through screening and treatment of eligible patients has the potential to prevent these sequelae. We assessed the cost-effectiveness in The Netherlands of systematically screening migrants from countries that have high and intermediate HBV infection levels. Methods: Epidemiologic data of the expected numbers of patients with active chronic HBV infection in the target population and information about the costs of a screening program were used in a Markov model and used to determine costs and quality-adjusted life years (QALY) for patients who were and were not treated. Results: Compared with the status quo, a 1-time screen for HBV infection can reduce mortality of liver-related diseases by 10%. Using base case estimates, the incremental cost-effectiveness ratio (ICER) of screening, compared with not screening, is euros (€) 8966 per QALY gained. The ICER ranged from €7936 to €11,705 based on univariate sensitivity analysis, varying parameter values of HBV prevalence, participation rate, success in referral, and treatment compliance. Using multivariate sensitivity analysis for treatment effectiveness, the ICER ranged from €7222 to €15,694; for disease progression, it ranged from €5568 to €60,418. Conclusions: Early detection and treatment of people with HBV infection can have a large impact on liver-related health outcomes. Systematic screening for chronic HBV infection among migrants is likely to be cost-effective, even using low estimates for HBV prevalence, participation, referral, and treatment compliance. © 2010 AGA Institute.

Author Keywords

[No Keywords available]

Index Keywords

Netherlands immigrant liver cirrhosis human priority journal probability Aged quality adjusted life year health care cost Adolescent male female patient referral liver transplantation chronic hepatitis liver cell carcinoma Article major clinical study adult cost control patient participation outcome assessment statistical model hepatitis B early diagnosis antivirus agent
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-75149182765&doi=10.1053%2fj.gastro.2009.10.039&partnerID=40&md5=de7da3f586728e92543beacc70ee72f6
DOI: 10.1053/j.gastro.2009.10.039
ISSN: 00165085
Cited by: 95
Original Language: English