Economic evaluations of HBV testing and treatment strategies and applicability to low and middle-income countries

Abstract

BackgroundMany people living with chronic HBV infection remain undiagnosed until later stages of disease. Increasing testing and treatment rates form part of the strategy to respond to the WHO goal of eliminating viral hepatitis as a public health threat by 2030. However, achieving these ambitious targets is dependent on finding effective and cost-effective methods of scale up strategies. The aim of this study was to undertake a narrative review of the literature on economic evaluations of testing and treatment for HBV infection, to help inform the development of the 2017 WHO Hepatitis Testing Guidelines.MethodsWe undertook a focussed literature review for economic evaluations on testing for HBV accompanied by antiviral treatment. The search was carried out in Pubmed and included only articles published after 2000 and written in English. We narratively synthesise the results and discuss the key drivers of cost-effectiveness and their applicability to low and middle-income countries (LMICs).ResultsNine published studies were included in this review, only one of which was performed in a low or middle-income setting in West Africa. Eight studies were performed in high-income settings, seven among high risk groups and one among the general population. The studies were heterogeneous in many respects including the population and testing strategy under consideration, model structure and baselines parameters, willingness to pay thresholds and outcome measures used. However, most studies found HBV testing and treatment to be cost-effective, even at low HBsAg prevalence levels.ConclusionsCurrently economic evaluations of HBV testing and treatment strategies in LMICs is lacking, therefore limiting the ability to provide formal recommendations on the basis of cost-effectiveness alone. Further implementation research is needed in order to help guide national policy planning.

Infectious Hepatitis B Negatively Impacts Lifestyles of Affected Individuals in Ejura-Sekyedumasi District of Ghana

“…It generally been speculated and supported by scientific investigations that -many people living with chronic HBV infection remain undiagnosed until later stages where the impacts of the disease are usually so huge and negatively challenging on the individuals affected. Also, increasing testing and treatment rates form part of the strategy to respond to the WHO goal of eliminating viral hepatitis as a public health threat by 2030 [44]. However, achieving these ambitious targets is still largely dependent on finding efficient and cost-effective HBV control intervention and scale up strategies [45].…”

A systematic review of hepatitis B screening economic evaluations in low- and middle-income countries

“…This is not a scenario explored by the antenatal screening studies from LMICs included in our review. Since database searching, a narrative review of ‘test and treat’ strategies as relevant to LMICs has been reported by Nayagam and colleagues [ 51 ]. Consistent with our findings, these authors were only able to find one relevant study conducted in LMICs [ 35 ].…”

Towards better diagnostic tools for liver injury in low-income and middle-income countries

“…In LMICs, liver injury is usually caused by infectious diseases, such as infectious hepatitis (typically B or C) and the side effects of HIV and TB medicines, which are toxic to the liver and result in drug-induced liver injury (DILI). Hepatitis prevalence,4 diagnosis5 6 and treatment7 8 are well studied. DILI is less understood in terms of burden statistics, diagnostic options and the prevention plans.…”