title: Screening and early treatment of migrants for chronic hepatitis B virus infection is cost-effective.
abstract: OBJECTIVE
  Persons with chronic hepatitis B virus (HBV) infection are at risk of developing cirrhosis and hepatocellular carcinoma. Early detection of chronic HBV infection through screening and treatment of eligible patients has the potential to prevent these sequelae. We assessed the cost-effectiveness in The Netherlands of systematically screening migrants from countries that have high and intermediate HBV infection levels.
  
  
  METHODS
  Epidemiologic data of the expected numbers of patients with active chronic HBV infection in the target population and information about the costs of a screening program were used in a Markov model and used to determine costs and quality-adjusted life years (QALY) for patients who were and were not treated.
  
  
  RESULTS
  Compared with the status quo, a 1-time screen for HBV infection can reduce mortality of liver-related diseases by 10%. Using base case estimates, the incremental cost-effectiveness ratio (ICER) of screening, compared with not screening, is euros (euro) 8966 per QALY gained. The ICER ranged from euro7936 to euro11,705 based on univariate sensitivity analysis, varying parameter values of HBV prevalence, participation rate, success in referral, and treatment compliance. Using multivariate sensitivity analysis for treatment effectiveness, the ICER ranged from euro7222 to euro15,694; for disease progression, it ranged from euro5568 to euro60,418.
  
  
  CONCLUSIONS
  Early detection and treatment of people with HBV infection can have a large impact on liver-related health outcomes. Systematic screening for chronic HBV infection among migrants is likely to be cost-effective, even using low estimates for HBV prevalence, participation, referral, and treatment compliance.
authors.affiliation: Division of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands. veldhuijzeni@ggd.rotterdam.nl
authors.forename: Irene K
authors.initials: IK
authors.lastname: Veldhuijzen
authors.forename: Mehlika
authors.initials: M
authors.lastname: Toy
authors.forename: Susan J M
authors.initials: SJ
authors.lastname: Hahné
authors.forename: G Ardine
authors.initials: GA
authors.lastname: De Wit
authors.forename: Solko W
authors.initials: SW
authors.lastname: Schalm
authors.forename: Robert A
authors.initials: RA
authors.lastname: de Man
authors.forename: Jan Hendrik
authors.initials: JH
authors.lastname: Richardus
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D019694:Hepatitis B, Chronic / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D019057:Quality-Adjusted Life Years; D014171:Transients and Migrants; D055815:Young Adult
chemical_list: D000998:Antiviral Agents