Cost-effectiveness of community interventions to promote awareness, testing and treatment of hepatitis B and C in migrant populations in Catalonia.

Interventions aimed at the diagnosis of viral hepatitis in migrants from countries with high prevalence rates are essential to achieve the elimination of viral hepatitis. The objective was to perform a cost-effectiveness analysis of a community screening strategy for hepatitis B and C virus (HBV and HCV) infections versus no intervention in migrant populations in Catalonia. HBV and HCV decision trees for the community strategy (from community screening to simplified access to care and treatment) and Markov models to simulate hepatitis B and C disease progression were developed. Sensitivity analyses were performed with the parameters with the highest uncertainty. Among the 2291 people screened, 74 and 21 cases of HBV and HCV infection were diagnosed, which avoided 79% and 62% of liver complications related to HBV and HCV, respectively. Community HCV screening showed an incremental cost of €13,999/patient versus no intervention and 2.98 quality-adjusted life years (QALYs) per patient, resulting in an incremental cost‒utility ratio of €4692/QALY gained. The HBV strategy was dominant. The distribution of HCV patients across different fibrosis stages had a greater impact on sensitivity analyses. Implementing a community screening strategy, which also increased awareness of HBV and HCV infections and treatment in migrant populations, is cost-effective.