BMJ Open
Volume 9, Issue 6, 2019

Chronic hepatitis B virus case-finding in UK populations born abroad in intermediate or high endemicity countries: An economic evaluation (Article) (Open Access)

Martin N.K. , Vickerman P. , Khakoo S. , Ghosh A. , Ramsay M. , Hickman M. , Williams J. , Miners A.*
  • a Department of Medicine, University of California San DiegoCA, United States, Population Health Sciences, University of Bristol, Bristol, United Kingdom
  • b Population Health Sciences, University of Bristol, Bristol, United Kingdom
  • c Clinical and Experimental Sciences, University of Southampton, Southampton, United Kingdom
  • d NHS London Borough of Bexley, London, United Kingdom
  • e Immunisation, Public Health England, London, United Kingdom, Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
  • f Population Health Sciences, University of Bristol, Bristol, United Kingdom
  • g Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
  • h Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom

Abstract

Objectives The majority (>90%) of new or undiagnosed cases of hepatitis B virus (HBV) in the UK are among individuals born in countries with intermediate or high prevalence levels (≥2%). We evaluate the cost-effectiveness of increased HBV case-finding among UK migrant populations, based on a one-time opt out case-finding approach in a primary care setting. Design Cost-effectiveness evaluation. A decision model based on a Markov approach was built to assess the progression of HBV infection with and without treatment as a result of case-finding. The model parameters, including the cost and effects of case-finding and treatment, were estimated from the literature. All costs were expressed in 2017/2018 British Pounds (GBPs) and health outcomes as quality-adjusted life-years (QALYs). Intervention Hepatitis B virus case-finding among UK migrant populations born in countries with intermediate or high prevalence levels (≥2%) in a primary care setting compared with no intervention (background testing). Results At a 2% hepatitis B surface antigen (HBsAg) prevalence, the case-finding intervention led to a mean incremental cost-effectiveness ratio of £13 625 per QALY gained which was 87% and 98% likely of being cost-effective at willingness to pay (WTP) thresholds of £20 000 and £30 000 per additional QALY, respectively. Sensitivity analyses indicated that the intervention would remain cost-effective under a £20 000 WTP threshold as long as HBsAg prevalence among the migrant population is at least 1%. However, the results were sensitive to a number of parameters, especially the time horizon and probability of treatment uptake. Conclusions HBV case-finding using a one-time opt out approach in primary care settings is very likely to be cost-effective among UK migrant populations with HBsAg prevalence ≥1% if the WTP for an additional QALY is around £20 000. © 2019 Author(s).

Author Keywords

Health economics hepatology economic evaluation Hepatitis B virus Case-finding Health services research

Index Keywords

primary medical care human diagnostic accuracy quality adjusted life year health care cost cost effectiveness analysis migrant intermediate risk population high risk population population research prevalence Article health care utilization willingness to pay United Kingdom endemic disease chronic hepatitis B cohort analysis hepatitis B surface antigen case finding antiviral therapy antivirus agent
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85068941306&doi=10.1136%2fbmjopen-2019-030183&partnerID=40&md5=8009119bfd66bdf657ade60df674262c
DOI: 10.1136/bmjopen-2019-030183
ISSN: 20446055
Original Language: English