Chronic hepatitis B virus case-finding in UK populations born abroad in intermediate or high endemicity countries: an economic evaluation

Natasha K Martin; Peter Vickerman; Salim Khakoo; Anjan Ghosh; Mary Ramsay; M Hickman; Jack Williams; Alec Miners

doi:10.1136/bmjopen-2019-030183

Chronic hepatitis B virus case-finding in UK populations born abroad in intermediate or high endemicity countries: an economic evaluation

BMJ Open. 2019 Jun 28;9(6):e030183. doi: 10.1136/bmjopen-2019-030183.

Authors

Natasha K Martin^{1

2}, Peter Vickerman², Salim Khakoo³, Anjan Ghosh⁴, Mary Ramsay^{5

6}, M Hickman², Jack Williams⁷, Alec Miners⁷

Affiliations

¹ Department of Medicine, University of California San Diego, La Jolla, California, USA.
² Population Health Sciences, University of Bristol, Bristol, UK.
³ Clinical and Experimental Sciences, University of Southampton, Southampton, UK.
⁴ NHS London Borough of Bexley, London, UK.
⁵ Immunisation, Public Health England, London, UK.
⁶ Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
⁷ Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.

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.

Keywords: case-finding; economic evaluation; health economics; health services research; hepatitis B virus; hepatology.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Communicable Diseases, Imported / epidemiology*
Cost-Benefit Analysis*
Endemic Diseases / statistics & numerical data*
Epidemiological Monitoring*
Hepatitis B, Chronic / epidemiology*
Humans
Risk Assessment / economics*
United Kingdom / epidemiology

Abstract

Publication types

MeSH terms

Grants and funding