Clinical—Liver, Pancreas, and Biliary TractScreening and Early Treatment of Migrants for Chronic Hepatitis B Virus Infection Is Cost-Effective
Section snippets
Patients and Methods
We used a Markov chain model to assess the costs and health outcomes of a cohort of patients who either experienced the natural history of HBV infection or received antiviral treatment. Comparative outcomes of these models, in terms of mortality, quality of life, and health care costs, were entered into a separate cost-effectiveness model containing all relevant variables of the screening program. The status quo includes a baseline level of detection of CHB infections through the existing
Results
The target population of 1.3 million migrants includes an estimated 44,000 HBsAg carriers, of whom 4466 are estimated to have active CHB. In the status quo, only 4% of patients with active CHB (173/4466) are expected to start treatment; the remainder are expected to follow the natural history of disease progression (Table 1). Lifetime follow-up of the cohort of active CHB patients suggests that 1073 (24%) of the 4466 patients will die of HBV-related diseases.
With a one-off screening program,
Discussion
We found that screening migrants for CHB infection with the goal of improving CHB outcome by early detection and treatment is cost-effective compared with the status quo. We estimate that the ICER of screening is approximately €9000 per QALY gained, well below the threshold of €20,000 per QALY gained that is commonly accepted in The Netherlands.45 Under the status quo, we estimated that only 4% of the population eligible for treatment is actually treated. By improving case detection through the
Acknowledgments
The authors thank Dr Ken Redekop from the Institute for Medical Technology Assessment for his help with the sensitivity analyses.
I.K.V. and M.T. contributed equally to the paper.
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Conflicts of interest The authors disclose the following: Prof. S.W. Schalm has received research grants and speaker's fees from GlaxoSmithKline and Bristol-Myers Squibb, respectively. The remaining authors disclose no conflicts.
Funding Supported by EU grant (LSHM-CT-2004-503359) VIRGIL to Erasmus MC and by an unrestricted grant from the Foundation for Liver Research to Erasmus MC.