Cost-Effectiveness of Universal Screening for Chronic Hepatitis B Virus Infection in China: An Economic Evaluation

Abstract

Background: With the largest hepatitis B virus (HBV) infected population worldwide, universal HBV screening in China may significantly contribute to the World Health Organization (WHO) 2030 goals in eliminating viral hepatitis. We evaluated the cost-effectiveness of universal HBV screening in China and identified optimal screening strategies. Methods: We conducted a cost-effectiveness analysis using a Markov cohort model based on four HBV serological screening methods in China. We simulated these universal screening in 15 different adult age groups with different initiation time (year 2021, 2026 and 2031). We performed probabilistic and one-way deterministic sensitivity analyses to assess the robustness of our findings. Results: With a willingness-to-pay level of 3x Chinese gross domestic product (GDP) per capita (US$30,828), HBsAg/HBsAb/HBeAg/HBeAb/HBcAb (five-test) screening among 18-70 years was the most cost-effective strategy in 2021 (incremental cost-effectiveness ratio [ICER] US$18,295/quality-adjusted life-year [QALY] gained). This remained the most cost-effective strategy, even when the willingness-to-pay threshold reduced to US$17,778; other strategies became more cost-effective at lower willingness-to-pay levels. This strategy would potentially prevent 3.46 million liver-related deaths over the lifetime of the cohort. It remained the most cost-effective even when the implementation was delayed to 2026 and 2031, but with greater ICERs (US$20,183/QALY and US$23,123/QALY, respectively). The screening will no longer be cost-effective in younger age groups in delayed scenarios. Conclusion: Five-test universal screening among 18-70 years implemented in 2021 is the optimal HBV screening strategy in China. Delaying strategy implementation reduces overall cost-effectiveness. Early screening initiation will aid global efforts in achieving viral hepatitis elimination. Funding: LZ is supported by the National Natural Science Foundation of China (grant number 8191101420); Outstanding Young Scholars Funding (3111500001); Xi'an Jiaotong University Basic Research and Profession Grant (xtr022019003); and Xi'an Jiaotong University Young Talent Support Program (YX6J004). WKS is supported by the Outstanding Young Researcher Award, the University of Hong Kong. JJO is supported by the Australian National Health and Medical Research Council Emerging Leadership Fellowship (GNT11953955). This project is funded by The University of Hong Kong Common Core Course. Declaration of Interest: PC is a staff member of the World Health Organization; the author alone is responsible for the views expressed in this publication, and they do not necessarily represent the decisions or policies of the World Health Organization. MFY is an advisory board member and/or received research funding from AbbVie, Arbutus Biopharma, Assembly Biosciences, Bristol Myer Squibb, Dicerna Pharmaceuticals, GlaxoSmithKline, Gilead Sciences, Janssen, Merck Sharp and Dohme, Clear B Therapeutics, Springbank Pharmaceuticals; and received research funding from Arrowhead Pharmaceuticals, Fujirebio Incorporation and Sysmex Corporation. WKS received speaker's fees from AstraZeneca and Mylan, is an advisory board member of CSL Behring, is an advisory board member and received speaker's fees from AbbVie, and is an advisory board member, received speaker's fees and researching funding from Gilead Sciences. The remaining authors have no conflict of interests.