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

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

Objectives: the 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. 

Design: cost-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).

Intervention: hepatitis 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). 

Results: at 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. 

Conclusions: HBV 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.

case-finding, economic evaluation, health economics, health services research, hepatitis B virus, hepatology
2044-6055
Martin, Natasha K.
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Vickerman, Peter
288014a9-9ed5-4207-adf5-64f63b0c6167
Khakoo, Salim
6c16d2f5-ae80-4d9b-9100-6bfb34ad0273
Ghosh, Anjan
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Ramsay, Mary
8320d895-e9d3-4abc-862e-fe923a4ac69d
Hickman, M.
278b63b4-126b-4db6-88a7-fcd9474d814c
Williams, Jack
68b155c3-c5b5-4b26-8cd8-7bfd8e46966f
Miners, Alec
00f4a0ec-6a07-44c7-b1a4-f44c5b3fb400
Martin, Natasha K.
e2c1561c-f4cd-41d8-b8d2-0cf57dcbb949
Vickerman, Peter
288014a9-9ed5-4207-adf5-64f63b0c6167
Khakoo, Salim
6c16d2f5-ae80-4d9b-9100-6bfb34ad0273
Ghosh, Anjan
6a0eb7b1-2ff7-4da4-89dd-b1d824431ee7
Ramsay, Mary
8320d895-e9d3-4abc-862e-fe923a4ac69d
Hickman, M.
278b63b4-126b-4db6-88a7-fcd9474d814c
Williams, Jack
68b155c3-c5b5-4b26-8cd8-7bfd8e46966f
Miners, Alec
00f4a0ec-6a07-44c7-b1a4-f44c5b3fb400

Martin, Natasha K., Vickerman, Peter, Khakoo, Salim, Ghosh, Anjan, Ramsay, Mary, Hickman, M., Williams, Jack and Miners, Alec (2019) Chronic hepatitis B virus case-finding in UK populations born abroad in intermediate or high endemicity countries: an economic evaluation. BMJ Open, 9 (6), [e030183]. (doi:10.1136/bmjopen-2019-030183).

Record type: Article

Abstract

Objectives: the 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. 

Design: cost-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).

Intervention: hepatitis 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). 

Results: at 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. 

Conclusions: HBV 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.

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Accepted/In Press date: 28 May 2019
Published date: 1 June 2019
Keywords: case-finding, economic evaluation, health economics, health services research, hepatitis B virus, hepatology

Identifiers

Local EPrints ID: 432833
URI: http://eprints.soton.ac.uk/id/eprint/432833
ISSN: 2044-6055
PURE UUID: dd0832a7-72d1-4135-b8bc-5e609d9fc21b

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Date deposited: 29 Jul 2019 16:30
Last modified: 07 Oct 2020 00:17

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Contributors

Author: Natasha K. Martin
Author: Peter Vickerman
Author: Salim Khakoo
Author: Anjan Ghosh
Author: Mary Ramsay
Author: M. Hickman
Author: Jack Williams
Author: Alec Miners

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