title: The cost-effectiveness of screening for chronic hepatitis B infection in the United States.
abstract: BACKGROUND
  Hepatitis B virus (HBV) continues to cause significant morbidity and mortality in the United States. Current guidelines suggest screening populations with a prevalence of ≥2%. Our objective was to determine whether this screening threshold is cost-effective and whether screening lower-prevalence populations might also be cost-effective.
  
  
  METHODS
  We developed a Markov state transition model to examine screening of asymptomatic outpatients in the United States. The base case was a 35-year-old man living in a region with an HBV infection prevalence of 2%. Interventions (versus no screening) included screening for Hepatitis B surface antigen followed by treatment of appropriate patients with (1) pegylated interferon-α2a for 48 weeks, (2) a low-cost nucleoside or nucleotide agent with a high rate of developing viral resistance for 48 weeks, (3) prolonged treatment with low-cost, high-resistance nucleoside or nucleotide, or (4) prolonged treatment with a high-cost nucleoside or nucleotide with a low rate of developing viral resistance. Effectiveness was measured in quality-adjusted life years (QALYs) and costs in 2008 US dollars.
  
  
  RESULTS
  Screening followed by treatment with a low-cost, high-resistance nucleoside or nucleotide was cost-effective ($29,230 per QALY). Sensitivity analyses revealed that screening costs <$50,000 per QALY in extremely low-risk populations unless the prevalence of chronic HBV infection is <.3%.
  
  
  CONCLUSIONS
  The 2% threshold for prevalence of chronic HBV infection in current Centers for Disease Control and Prevention/US Public Health Service screening guidelines is cost-effective. Furthermore, screening of adults in the United States in lower-prevalence populations (eg, as low as .3%) also is likely to be cost-effective, suggesting that current health policy should be reconsidered.
authors.affiliation: Division of General Internal Medicine and the Center for Clinical Effectiveness, Ohio, USA. mark.eckman@uc.edu
authors.forename: Mark H
authors.initials: MH
authors.lastname: Eckman
authors.forename: Tiffany E
authors.initials: TE
authors.lastname: Kaiser
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Sherman
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D006514:Hepatitis B Surface Antigens / Q000097:blood; D019694:Hepatitis B, Chronic / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000379:methods*; D015233:Models, Statistical; D015995:Prevalence; D014481:United States / Q000453:epidemiology
chemical_list: D000998:Antiviral Agents; D006514:Hepatitis B Surface Antigens