Chronic hepatitis B virus case-finding in UK populations born abroad in intermediate or high endemicity countries: an economic evaluation. Issue 6 (28th June 2019)

• Record Type: Journal Article
• Authors: Martin, Natasha K; Vickerman, Peter; Khakoo, Salim; Ghosh, Anjan; Ramsay, Mary; Hickman, M; Williams, Jack; Miners, Alec
• Is Part Of: BMJ open. Volume 9:Issue 6(2019)
• Publication Date: 2019-06-28
• Subjects: hepatology -- hepatitis B virus -- health economics -- economic evaluation -- case-finding -- health services research; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2019-030183
• Languages: English
• ISSNs: 2044-6055

Abstract

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.