Cost-Effectiveness of Universal Screen-and-Treat Strategies for Reducing Morbidity and Mortality of Chronic Hepatitis B in a High-Endemicity City.

In the setting of high hepatitis B virus (HBV) endemicity, we studied the cost-effectiveness of universal HBV screen-and-treat strategies for averting HBV-related morbidity and mortality in Hong Kong, where diagnosis and treatment coverages are low. An age-sex-specific compartmental model for 2000-2040 was developed, with the incorporation of population-based screening strategies targeting different age groups. With a one-time HBV screening programme in 2025-2029, 3.6%-8.9% of HBV-related deaths could be averted. We evaluated the cost-effectiveness of the screening strategies with primary-care-based management in different scenarios with components of annual drug cost levels, screening programme duration, starting year and targeted age groups. Incremental cost-effectiveness ratio (ICER) was calculated, with the willingness-to-pay (WTP) threshold set at USD100,000/quality-adjusted life years (QALY). At the standard drug cost level, only the screening strategy targeting the 40-49 years old is cost-saving. When drug cost decreases to a low level, the strategy targeting the 35-49 years old (ICER USD97,042/QALY gained) is likely to be cost-effective and screening 35-59 years old is marginally cost-effective. In probabilistic sensitivity analysis, screening 40-49 years old (50%) and 35-59 years old (42%) have a half-half probability of being the most cost-effective at USD100,000/QALY WTP threshold, but increased to 93% for screening 35-59 years old at USD150,000/QALY threshold. From scenario analysis, deferred initiation of screening and unlimited programme duration would increase the ICER. Universal HBV screening targeting individuals aged 35-59 years or 40-49 years in the general population, with an earlier start and limited duration of the programme, is likely to be cost-effective.