Cost-Effectiveness of Screening and Vaccinating Asian and Pacific Islander Adults for Hepatitis B

Hutton, David; Tan, Daniel S.W.; So, Samuel; Brandeau, Margaret L.

doi:10.7326/0003-4819-147-7-200710020-00004

Cited by 137 publications

(150 citation statements)

References 56 publications

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“…This is not unexpected: threshold results have been found when comparing various combinations of screening, testing, and vaccination strategies for other diseases, e.g., Hutton et al (2007); Rubió (1997); Owens et al (1996).…”

Section: Unchanged Prevalencementioning

confidence: 88%

Optimal mix of screening and contact tracing for endemic diseases

Armbruster

Brandeau

2007

Mathematical Biosciences

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Two common means of controlling infectious diseases are screening and contact tracing. Which should be used, and when? We consider the problem of determining the cheapest mix of screening and contact tracing necessary to achieve a desired endemic prevalence of a disease or to identify a specified number of cases. We perform a partial equilibrium analysis of small-scale interventions, assuming that prevalence is unaffected by the intervention; we develop a full equilibrium analysis where we compare the long-term cost of various combinations of screening and contact tracing needed to achieve a given equilibrium prevalence; and we solve the problem of minimizing the total costs of identifying and treating disease cases plus the cost of untreated disease cases. Our analysis provides several insights. First, contact tracing is only cost effective when prevalence is below a threshold value. This threshold depends on the relative cost per case found by screening versus contact tracing. Second, for a given contact tracing policy, the screening rate needed to achieve a given prevalence or identify a specified number of cases is a decreasing function of disease prevalence. As prevalence increases above the threshold (and contact tracing is discontinued), the screening rate jumps discontinuously to a higher level. Third, these qualitative results hold when we consider unchanged or changed prevalence, and short-term or long-term costs.

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Section: Unchanged Prevalencementioning

confidence: 88%

Optimal mix of screening and contact tracing for endemic diseases

Armbruster

Brandeau

2007

Mathematical Biosciences

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“…A recent economic evaluation has analysed several alternative strategies targeting Asian and Pacific Islander adults in the USA, with an integrated approach being one of these strategies (Hutton et al 2007). Against a status quo of voluntary screening only, the four incremental strategies considered were: a) a universal vaccination strategy -all individuals receive 3 doses of vaccine; b) a screen and treat strategy -individuals are tested for chronic HBV infection with those testing positive being referred for treatment; c) a screen, treat and ring vaccinate strategy which is strategy (b) plus screening and vaccination (if needed) of close contacts of those infected; and d) a screen, treat and vaccinate strategy applied to all individuals in the target population.…”

Section: Integrated Screening/vaccination/treatment Programsmentioning

confidence: 99%

A survey of Sydney general practitioners' management of patients with chronic hepatitis B

Najjar

Gupta

Pritchard-Jones

et al. 2016

Medical Journal of Australia

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Objective: To examine the chronic hepatitis B (CHB) assessment and management practices of general practitioners in the Sydney and South Western Sydney Local Health Districts, areas with a high prevalence of CHB, and to obtain their views on alternative models of care. Design, setting and participants: We used a descriptive, cross‐sectional study design to survey GPs who had seen at least one patient aged 18 years or over who had been notified as having CHB to the Public Health Unit between 1 June 2012 and 31 May 2013. There were 213 eligible GPs; the response rate was 57.7%. Main outcome measures: The CHB assessment, management and referral practices of the GPs, and their opinions about different models of care. Results: Most GPs (78.9%) were at least reasonably confident about managing CHB. GPs were generally most comfortable with a model of care that involved initial referral to a specialist; managing CHB without specialist input or with only review by a specialised nurse practitioner were less popular. Conclusion: These results suggest that barriers, including dependence on specialist input, still hinder the appropriate assessment and management of CHB patients by GPs. Well designed and targeted support programs that include specialist support are needed if there is to be a successful shift to an increased role for GPs in the model of care for managing CHB.

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“…ACIP also recommends that the small percentage (5%) of infants who fail to respond to an initial HepB vaccine series and remain uninfected receive an additional HepB vaccine series and repeat postvaccination serologic testing (PVST). Although economic analyses of the burden and prevention impact of HBV transmission have been conducted, 2,[5][6][7][8][9][10] no study has focused on the long-term costs and outcomes of PEP through the current national PHBPP. This study analyzes the effects of the PHBPP on health and economic outcomes attributable to perinatal and early childhood infection (postnatal infection, before age 5 years), determined over the lifetime of the 2009 US birth cohort.…”

Section: Resultsmentioning

confidence: 99%

Cost-effectiveness Analysis of the National Perinatal Hepatitis B Prevention Program

et al. 2014

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METHODS:A decision analytic tree and a long-term Markov model represented the risk of perinatal and childhood infections under different prevention alternatives, and the long-term health and economic consequences of HepB infection. Outcome measures were the number of perinatal infections and childhood infections from infants born to HepB surface antigen-positive women, quality-adjusted life-years (QALYs), lifetime costs, and incremental cost per QALY gained. The health outcomes and total costs of each strategy were compared incrementally. Costs were evaluated from the health care system perspective and expressed in US dollars at a 2010 price base. RESULTS:In all analyses, the PHBPP increased QALYs and led to higher reductions in the number of perinatal and childhood infections than no PHBPP, with a cost-effectiveness ratio of $2602 per QALY. In sensitivity analyses, the cost-effectiveness ratio was robust to variations in model inputs, and there were instances where the program was both more effective and cost saving.CONCLUSIONS: This study indicated that the current PHBPP represents a cost-effective use of resources, and ensuring the program reaches all pregnant women could present additional public health benefits.

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Cost-Effectiveness of Screening and Vaccinating Asian and Pacific Islander Adults for Hepatitis B

Cited by 137 publications

References 56 publications

Optimal mix of screening and contact tracing for endemic diseases

Optimal mix of screening and contact tracing for endemic diseases

A survey of Sydney general practitioners' management of patients with chronic hepatitis B

Cost-effectiveness Analysis of the National Perinatal Hepatitis B Prevention Program

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