The cost-effectiveness of universal hepatitis B screening in Vietnam.

OBJECTIVES

Chronic hepatitis B (CHB) remains a major public health challenge in Vietnam, with an estimated 7.5% of the population infected. The aim was to evaluate the cost-effectiveness of a one-time universal CHB screening strategy.

METHODS

A Markov model was used to assess the clinical health impact and cost-effectiveness of a one-time universal screening in Vietnam, with subsequent CHB monitoring and treatment, compared to the current practice. Sensitivity analyses were performed to identify thresholds for cost-effectiveness based on a willingness-to-pay threshold of $12,000/quality-adjusted life year (QALY). Scenario analysis was performed to assess what the cost-effectiveness of screening would be if treatment rates were to increase.

RESULTS

The incremental cost-effectiveness ratio was calculated to be $3609 per QALY, with an incremental cost difference of $162,730 and an incremental effect difference of 45.1 QALYs per 100,000 adults screened. Compared to current practice, universal screening would avert an additional 0.5 cases of newly developed cirrhosis, 1.1 cases of newly developed decompensated cirrhosis, 1.3 cases of newly developed hepatocellular carcinoma, 0.5 liver transplantations and 5.7 chronic hepatitis B virus-related deaths, per 100,000 adults screened.

CONCLUSION

A one-time universal screening is likely to be cost-effective under the current willingness-to-pay threshold. Clinical impact would be increased if linkage to care and treatment rates were to be improved.