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

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e030183 ◽  
Author(s):  
Natasha K Martin ◽  
Peter Vickerman ◽  
Salim Khakoo ◽  
Anjan Ghosh ◽  
Mary Ramsay ◽  
...  
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Cost Effective ◽  
Case Finding ◽  
Hbsag Prevalence ◽  
Migrant Populations ◽  
Additional Qaly ◽  
B Virus

ObjectivesThe 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.DesignCost-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).InterventionHepatitis 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).ResultsAt 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.ConclusionsHBV 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.

scholarly journals The Effectiveness and Cost-Effectiveness of Screening for and Vaccination Against Hepatitis B Virus among Migrants in the EU/EEA: A Systematic Review

2018 ◽  
Vol 15 (9) ◽  
pp. 1898 ◽  
Author(s):  
Daniel Myran ◽  
Rachael Morton ◽  
Beverly-Ann Biggs ◽  
Irene Veldhuijzen ◽  
Francesco Castelli ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cost Effectiveness ◽  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Cost Effective ◽  
European Economic Area ◽  
The European Union ◽  
Vaccination Programs ◽  
B Virus ◽  
The Eu

Migrants from hepatitis B virus (HBV) endemic countries to the European Union/European Economic Area (EU/EEA) comprise 5.1% of the total EU/EEA population but account for 25% of total chronic Hepatitis B (CHB) infection. Migrants from high HBV prevalence regions are at the highest risk for CHB morbidity. These migrants are at risk of late detection of CHB complications; mortality and onwards transmission. The aim of this systematic review is to evaluate the effectiveness and cost-effectiveness of CHB screening and vaccination programs among migrants to the EU/EEA. We found no RCTs or direct evidence evaluating the effectiveness of CHB screening on morbidity and mortality of migrants. We therefore used a systematic evidence chain approach to identify studies relevant to screening and prevention programs; testing, treatment, and vaccination. We identified four systematic reviews and five additional studies and guidelines that reported on screening and vaccination effectiveness. Studies reported that vaccination programs were highly effective at reducing the prevalence of CHB in children (RR 0.07 95% CI 0.04 to 0.13) following vaccination. Two meta-analyses of therapy for chronic HBV infection found improvement in clinical outcomes and intermediate markers of disease. We identified nine studies examining the cost-effectiveness of screening for CHB: a strategy of screening and treating CHB compared to no screening. The median acceptance of HB screening was 87.4% (range 32.3–100%). Multiple studies highlighted barriers to and the absence of effective strategies to ensure linkage of treatment and care for migrants with CHB. In conclusion, screening of high-risk children and adults and vaccination of susceptible children, combined with treatment of CHB infection in migrants, are promising and cost-effective interventions, but linkage to treatment requires more attention.

Cost-Effectiveness of Universal Hepatitis B Virus Screening in Patients Beginning Chemotherapy for Solid Tumors

2011 ◽  
Vol 29 (24) ◽  
pp. 3270-3277 ◽  
Author(s):  
Fiona L. Day ◽  
Jonathan Karnon ◽  
Danny Rischin
Keyword(s):  
Cost Effectiveness ◽  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Universal Screening ◽  
Cost Effective ◽  
Screening Strategy ◽  
Sensitivity Analyses ◽  
B Virus ◽  
The Cost ◽  
Hbv Screening

PurposeUniversal screening for chronic hepatitis B virus (HBV) infection before chemotherapy has been recommended. We evaluated the cost-effectiveness of HBV screening before chemotherapy given for nonhematopoietic solid tumors (STs).MethodsA decision-analytic model was used to compare the cost-effectiveness of universal screening conducted per professional guidelines versus no screening in hypothetical patient cohorts beginning adjuvant chemotherapy for early breast cancer or palliative chemotherapy for advanced non–small-cell lung cancer. Survival times were extrapolated using Markov models. Probabilities were derived from published studies and costs estimated from the perspective of the Australian health care system. One-way and probabilistic sensitivity analyses were performed, including with the application of an alternative HBV screening strategy.ResultsUsing an incremental cost-effectiveness ratio threshold of $50,000 (Australian dollars) per life-year (LY) saved, universal HBV screening was not cost-effective for adjuvant patients ($88,224/LY, 13% probability of being cost-effective), palliative patients ($1,344,251/LY, 0%), or pooled (all) patients ($149,857/LY, 1%). Sensitivity analyses found that screening approached cost-effectiveness among adjuvant patients with the highest reported rates of undiagnosed chronic HBV (65%, $59,445/LY) or HBV reactivation with chemotherapy (41%, $56,537/LY). Cost- effectiveness was also significantly influenced by HBV population prevalence. An alternative screening strategy using hepatitis B surface antigen testing only produced the most economically favorable results, with $30,126/LY (80% probability) for adjuvant patients and $51,201/LY (43%) for the pooled cohort.ConclusionUniversal HBV screening conducted per current guidelines is not cost-effective in patients with STs. Screening may be economically favorable in selected patient subpopulations and/or with simplification of the screening strategy.

scholarly journals Cost-effectiveness of antiviral therapy during late pregnancy to prevent perinatal transmission of hepatitis B virus

PeerJ ◽  
2016 ◽  
Vol 4 ◽  
pp. e1709 ◽  
Author(s):  
Wenjun Wang ◽  
Jingjing Wang ◽  
Shuangsuo Dang ◽  
Guihua Zhuang
Keyword(s):  
Cost Effectiveness ◽  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Antiviral Therapy ◽  
Late Pregnancy ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
B Virus ◽  
The Cost ◽  
Hbv Transmission

Background.Hepatitis B virus (HBV) infections are perinatally transmitted from chronically infected mothers. Supplemental antiviral therapy during late pregnancy with lamivudine (LAM), telbivudine (LdT), or tenofovir (TDF) can substantially reduce perinatal HBV transmission compared to postnatal immunoprophylaxis (IP) alone. However, the cost-effectiveness of these measures is not clear.Aim.This study evaluated the cost-effectiveness from a societal perspective of supplemental antiviral agents for preventing perinatal HBV transmission in mothers with high viral load (>6 log10copies/mL).Methods.A systematic review and network meta-analysis were performed for the risk of perinatal HBV transmission with antiviral therapies. A decision analysis was conducted to evaluate the clinical and economic outcomes in China of four competing strategies: postnatal IP alone (strategy IP), or in combination with perinatal LAM (strategy LAM + IP), LdT (strategy LdT + IP), or TDF (strategy TDF + IP). Antiviral treatments were administered from week 28 of gestation to 4 weeks after birth. Outcomes included treatment-related costs, number of infections, and quality-adjusted life years (QALYs). One- and two-way sensitivity analyses were performed to identify influential clinical and cost-related variables. Probabilistic sensitivity analyses were used to estimate the probabilities of being cost-effective for each strategy.Results.LdT + IP and TDF + IP averted the most infections and HBV-related deaths, and gained the most QALYs. IP and TDF + IP were dominated as they resulted in less or equal QALYs with higher associated costs. LdT + IP had an incremental $2,891 per QALY gained (95% CI [$932–$20,372]) compared to LAM + IP (GDP per capita for China in 2013 was $6,800). One-way sensitivity analyses showed that the cost-effectiveness of LdT + IP was only sensitive to the relative risk of HBV transmission comparing LdT + IP with LAM + IP. Probabilistic sensitivity analyses demonstrated that LdT + IP was cost-effective in most cases across willingness-to-pay range of $6,800 ∼ $20,400 per QALY gained.Conclusions.For pregnant HBV-infected women with high levels of viremia, supplemental use of LdT during late pregnancy combined with postnatal IP for infants is cost-effective in China.

Evaluating the cost-effectiveness of universal hepatitis B virus vaccination in Iran: a Markov model analysis

2021 ◽  
pp. 1-9
Author(s):  
Ali Mohammad Mokhtari ◽  
Mohsen Barouni ◽  
Mohsen Moghadami ◽  
Jafar Hassanzadeh ◽  
Rebecca Susan Dewey ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Markov Model ◽  
Model Analysis ◽  
Virus Vaccination ◽  
B Virus ◽  
The Cost

scholarly journals A Serological Survey of Selected Papua New Guinea Blood Donors for Hepatitis B and Related Co-Infections

2020 ◽  
Vol 5 (3) ◽  
pp. 108
Author(s):  
Francisca Varpit ◽  
Bruce Gummow
Keyword(s):  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Papua New Guinea ◽  
New Guinea ◽  
Perinatal Transmission ◽  
Health Campaigns ◽  
Hbsag Prevalence ◽  
Immunization Program ◽  
Positive Hbsag ◽  
B Virus

Hepatitis B virus (HBV) infection is a serious problem and earlier studies in Papua New Guinea have reported a high prevalence of hepatitis B virus infection. These studies were undertaken using insensitive tests and before an expanded immunization program. The current HBV status is therefore uncertain. A retrospective study to investigate the HBV status was carried out using blood donor data at Nonga General Hospital, East New Britain Province, Papua New Guinea, from January 2003 to December 2018. Additional data for Human Immunodeficiency Virus, syphilis and hepatitis C virus were also collected. Data were analysed using NCSS statistical software. The mean hepatitis B antigen (HBsAg) sero-prevalence was 21% for the period of study and showed a downward trend over the period of the study, which may reflect the effect of the extended immunization program. HBsAg prevalence in male donors (23%) was significantly higher than females (16%). Donors living in Pomio district had a significantly lower proportion of sero-positive HBsAg donors (7%) than Gazelle (22%), Kokopo (22%) and Rabaul (20%), which was attributed to this district’s geographical isolation. Ethnically, Pomios donors (8%) had significantly lower HBsAg prevalence than the Taulils, (29%), Bainings (21%) and Tolais (21%). Fifteen to nineteen year olds (23%) were the predominant age group affected, and vertical or perinatal transmission was probably the primary transmission route. Our findings call for greater awareness on the part of public policy makers and should be considered when planning future public health campaigns.

Nurse Volunteers in School-Based Hepatitis B Immunization Programs

2001 ◽  
Vol 17 (4) ◽  
pp. 185-188 ◽  
Author(s):  
Hayley Mark ◽  
Verna G. Conklin ◽  
Margaret C. Wolfe
Keyword(s):  
Hepatitis B Virus ◽  
Hepatitis B ◽  
School Health ◽  
Cost Effective ◽  
Local Health ◽  
Vaccination Programs ◽  
School Year ◽  
School Based ◽  
B Virus ◽  
And Training

School districts across the nation are implementing school-based hepatitis B virus vaccination programs. Because adolescents are at risk of contracting hepatitis B virus, these programs are important in preventing infections. Critical to the success of these programs is having qualified and cost-effective health professionals to administer the vaccine. This article describes the recruitment and training of professional nurse volunteers to administer vaccines in school-based clinics. During the 1998–1999 school year, approximately 60 nurses in Durham, North Carolina, volunteered 300 hours of time to the program. In the first year, the cost of recruiting and training volunteers exceeded the savings from salaried school nurse time. However, savings are expected in future years. Other benefits of recruiting volunteers to administer vaccine include allowing school nurses to remain in their usual assignments, increasing awareness of the health department’s mission and school health in the community, and improving collaboration among local health agencies.

Cost-effectiveness of targeted screening for hepatitis C in The Netherlands

2011 ◽  
Vol 140 (1) ◽  
pp. 58-69 ◽  
Author(s):  
C. W. HELSPER ◽  
B. A. BORKENT-RAVEN ◽  
N. J. DE WIT ◽  
G. A. VAN ESSEN ◽  
M. J. M. BONTEN ◽  
...  
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Hepatitis C ◽  
The Netherlands ◽  
Drug Users ◽  
Cost Effective ◽  
Case Finding ◽  
Hard Drug ◽  
Effective Interventions ◽  
Additional Support

SUMMARYOn account of the serious complications of hepatitis C virus (HCV) infection and the improved treatment possibilities, the need to improve HCV awareness and case-finding is increasingly recognized. To optimize a future national campaign with this objective, three pilot campaigns were executed in three regions in The Netherlands. One campaign was aimed at the general population, a second (similar) campaign was extended with a support programme for primary care and a third campaign was specifically aimed at hard-drug users. Data from the pilot campaigns were used to build a mathematical model to estimate the incremental cost-effectiveness ratio of the different campaigns. The campaign aimed at the general public without support for primary care did not improve case-finding and was therefore not cost-effective. The similar campaign accompanied by additional support for primary care and the campaign aimed at hard-drug users emerged as cost-effective interventions for identification of HCV carriers.

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