Enhancing the hepatitis B care cascade in Australia: A cost‐effectiveness model

Abstract

If Australia is to successfully eliminate hepatitis B as a public health threat, it will need to enhance the chronic hepatitis B (CHB) care cascade. This study used a Markov model to assess the impact, cost and cost‐effectiveness of scaling up CHB diagnosis, linkage to care and treatment to reach national and international elimination targets for hepatitis B in Australia. Compared to continued current trends, the model calculated the difference in care cascade projection, disability‐adjusted life years (DALYs), costs and the incremental cost‐effectiveness ratio (ICER), of scaling up CHB diagnosis, linkage to care and treatment to reach: (a) Australia's 2022 national targets and (b) the WHO’s 2030 global targets. Achieving the national and WHO targets had ICERs of A$13 435 (A$10 236‐A$21 165) and A$14 482 (A$13 031‐A$25 641) per DALY averted between 2016 and 2030 in Australia, respectively. However, this excluded implementation and demand generation costs. The ICER for the National Strategy and WHO Strategy remained under A$50 000 per DALY averted if Australia spent up to A$328 or A$538 million, respectively, per annum (for 2016‐2030) on implementation and demand generation activities. Sensitivity analysis showed that cost‐effectiveness was predominately driven by the cost of CHB treatment and influenced by disease progression rates. Hence for Australia to reach the National Hepatitis B Strategy 2022 targets and WHO Strategy 2030 targets, it requires an improvement in the CHB care cascade. We estimated it is cost‐effective to spend up to A$328 million or A$538 million per year to reach the National and WHO Strategy targets, respectively.

Time for universal hepatitis B screening for Australian adults

“…A 2009 study found that appropriate treatment was not only cost‐effective but more so than many currently existing population‐based cancer prevention programs 14 . More recent research has also suggested that improving the hepatitis B cascade of care in Australia is cost‐effective 15 …”

“… 14 More recent research has also suggested that improving the hepatitis B cascade of care in Australia is cost‐effective. 15 …”

The forgotten people: Hepatitis B virus (HBV) infection as a priority for the inclusion health agenda

“…Multiple studies have demonstrated cost-effectiveness of HBV screening in a variety of different scenarios, including community-based outreach and low prevalence settings ( Su et al, 2022 , Xiao et al, 2020 , Toy et al, 2022 , Nayagam et al, 2016 , Tordrup et al, 2020 , Hutton et al, 2022 , Wright et al, 2018 ). This is largely due to averting high costs associated with decompensated cirrhosis, HCC and liver transplantation.…”

Trends in decompensated cirrhosis and hepatocellular carcinoma among people with a hepatitis B notification in New South Wales

“…In Australia, the epidemiology of HBV is complex, with a high prevalence among migrants from high-or J o u r n a l P r e -p r o o f intermediate HBV prevalence countries and Aboriginal or Torres Strait Islander peoples (15,16). Over the past two decades, remarkable strides have been made in increasing HBV diagnosis, vaccination and treatment uptake (17) and understanding the epidemiology, risk factors, and molecular profiles of HBV-related DC and HCC (18). However, enhanced HBV diagnosis and treatment uptake are needed if Australia is to achieve the WHO 2030 elimination targets (6).…”