Cost-Effectiveness of Hepatitis B Mass Screening and Management in High-Prevalent Rural China: A Model Study From 2020 to 2049

Abstract

Background: Chronic hepatitis B is highly prevalent among adults in rural China and better management of those populations is of vital importance for viral hepatitis elimination. Adult immunization has been the subject of much controversy in previous studies. This study estimates the cost-effectiveness of population-based hepatitis B screening, treatment, and immunization strategy (comprehensive strategy) in rural areas with high prevalence under the national policy of sharp-drop drug prices. Methods: We constructed a Markov model comparing 4 strategies in a 30-year horizon from the healthcare payer perspective: (1) the conventional pattern; (2) screening and treating infected (treatment); (3) screening and immunizing susceptible individuals (immunization); and (4) the comprehensive strategy. Screening intensity ranged from 50% to 100%. Outcomes were measured by costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), and clinical outcomes. Results: The costs for the conventional pattern, treatment strategy, immunization strategy, and comprehensive strategy were US$ 341, 351, 318, and 323, respectively. In addition, effects were 17.45, 17.57, 17.46, and 17.58 QALYs, respectively. The ICER of the comprehensive strategy was 35 US$/QALY gained at 50% screening intensity and 420 US$/QALY gained at 100%. The net monetary benefit increased with increasing screening intensity and declined after 90%, with the highest value of US$ 40693. All new infections and 52.5% mortality could be avoided from 2020 to 2049 if all patients were properly treated and all susceptible individuals were immunized. The results were stable within a wide range of parameters. Conclusions: It was cost-effective to implement the mass hepatitis B screening, treatment, and immunization strategy in areas of rural China with high prevalence, and the strategy gained the most net monetary benefit at a screening intensity of 90%. Although it was impractical to fulfill 100% coverage, efforts should be made to obtain more people screened.

Effect of a Community-Based Hepatitis B Virus Infection Detection Combined with Vaccination Program in China

“…The modeling studies of China showed that launching an extensive adult HBV infection screening and vaccination program can effectively reduce incidence and mortality, and it is cost-effective [10,11]. Our research provides real-world evidence for this.…”

“…In 2016, a modeling study in China reported that HBV infection screening and hepatitis B vaccination in adults aged 21-39 years can prevent 1.9 million HBV infections and 56,000 HBV-related early deaths [10]. Another modeling study in 2021 in China has revealed that HBV infection screening and hepatitis B vaccination for adults yield 18.08 life years and 17.46 qualityadjusted life years [11]. However, the evidence for the effectiveness of such public health projects funded by the government is insufficient.…”

Changing incidence of hepatitis B and persistent infection risk in adults: a population-based follow-up study from 2011 in China

“…The same vaccination program was also piloted in Keqiao and Tonglu. Our previous economic analysis based on the Markov model has demonstrated that population-based immunization could prevent most new HBV infections if all susceptible individuals were vaccinated and this strategy was cost-effective [ 25 ]. However, the interventions may have little impact when HBV incidence has dropped to a lower level and the incidence reached a plateau in the last round.…”

“…This indicated that the prevention and control of HBV infection in high-prevalence areas was still challenging. Screening HBV infection and immunization for young adults have been proved to be cost-effective in China [ 25 , 43 ]. Free vaccination could be considered for susceptible adults to avoid new infections.…”

“…Younger participants also had a greater likelihood of persistent infection, suggesting that prevention and control were more challenging in this population because it was difficult to monitor their infection situation. Population-based HBV screening should be encouraged considering it was cost-effective in our previous research [ 25 ].…”