title: Cost effectiveness of screening immigrants for hepatitis B.
abstract: BACKGROUND
  The prevalence of chronic hepatitis B (CHB) infection among the immigrants of North America ranges from 2 to 15%, among whom 40% develop advanced liver disease. Screening for hepatitis B surface antigen is not recommended for immigrants.
  
  
  OBJECTIVE
  The objective of this study is to estimate the health and economic effects of screening strategies for CHB among immigrants.
  
  
  METHODS
  We used the Markov model to examine the cost-effectiveness of three screening strategies: (i) 'No screening'; (ii) 'Screen and Treat' and (iii) 'Screen, Treat and Vaccinate' for 20-65 years old individuals who were born abroad but are currently living in Canada. Model data were obtained from the published literature. We measured predicted hepatitis B virus (HBV)-related deaths, costs (2008 Canadian Dollars), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER).
  
  
  RESULTS
  Our results show that screening all immigrants will prevent 59 HBV-related deaths per 10, 000 persons screened over the lifetime of the cohort. Screening was associated with an increase in quality-adjusted life expectancy (0.024 QALYs) and cost ($1665) per person with an ICER of $69, 209/QALY gained compared with 'No screening'. The 'Screen, Treat and Vaccinate' costs an additional $81, generates an additional 0.000022 QALYs per person, with an ICER of $3, 648,123/QALY compared with the 'Screen and Treat'. Sensitivity analyses suggested that the 'Screen and Treat' is likely to be moderately cost-effective.
  
  
  CONCLUSIONS
  We show that a selective hepatitis B screening programme targeted at all immigrants in Canada is likely to be moderately cost-effective. Identification of silent CHB infection with the offer of treatment when appropriate can extend the lives of immigrants at reasonable cost.
authors: Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, ON, Canada. william.wong@theta.utoronto.ca
authors: William W L
authors: WW
authors: Wong
authors: Gloria
authors: G
authors: Woo
authors: E
authors: E
authors: Jenny Heathcote
authors: Murray
authors: M
authors: Krahn
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use; D002170:Canada / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D054242:Emigrants and Immigrants; D017048:Health Care Costs; D017325:Hepatitis B Vaccines / Q000191:economics; D019694:Hepatitis B, Chronic / Q000175:diagnosis* / Q000191:economics* / Q000401:mortality / Q000517:prevention & control / Q000628:therapy; D006801:Humans; D016031:Liver Transplantation / Q000191:economics; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D018803:Models, Economic; D011237:Predictive Value of Tests; D015995:Prevalence; D019057:Quality-Adjusted Life Years; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D017325:Hepatitis B Vaccines