Universal HBV screening in China is cost-effective, the earlier the better

A/Prof Lei Zhang is senior author on a paper modelling early
diagnostic screening for HBV infection in China

China has one of the largest disease burdens of hepatitis B virus (HBV) infections worldwide, accounting for one-third of the world's infected population. If uncontrolled, chronic HBV infection can lead to liver cirrhosis and liver cancer. 

However, estimated only 19% of chronic HBV-infected people are diagnosed in China, versus the 90% target set by the WHO for HBV elimination by 2030. A universal HBV screening program may improve diagnostic rates and aid China in reaching the WHO 2030 target. 

Associate Professor Lei Zhang (Melbourne Sexual Health Centre) is the senior author on the paper. He said, "This present study aims to establish the most cost-effective HBV screening strategy in China and provide evidence for health resource allocation in preventing and treating HBV."

The study used a decision-tree model to assess the cost-effectiveness of four HBV serological screening strategies in China in different screening scenarios. 

A/Prof Zhang said, "We simulated universal screening scenarios in 15 adult age groups between 18 and 70 years, with various years of screening implementation (2021, 2026, and 2031), compared to the current status quo of no screening. 

"In total, we investigated 180 different screening scenarios with a Markov model to simulate disease progression of HBV infection to cirrhosis and liver cancer in individuals aged 18–80 years."

Based on the willingness-to-pay in reference to China's GDP, A/Prof Zhang said that all 180 universal screening scenarios were cost-effective compared with the status quo. 

"The strategy of complete HBV serological screening with five screening items in individuals aged 18–70 years is currently the most cost-effective strategy. It has an incremental cost-effectiveness ratio (ICER) US$18,295/quality-adjusted life-years (QALY) gained. 

"But if screening implementation is delayed, ICER will substantially increase with the screening in younger individuals no longer cost-effective. Universal HBV screening in China will increase diagnostic rates to 86.8%, increase treatment rates, and prevent 3.46 million liver-related deaths over the current life expectancy of the Chinese population"

Among these scenarios, he said, implementing universal HBV screening in individuals aged 18-70 years within the next 10 years is the optimal HBV screening strategy for China. "And doing so as soon as possible maximises its population benefits by reducing as much as 3.5 million HBV-related deaths in China. Alternative screening strategies could be cost-effective if there were budget limitations in rural areas."

This is a joint collaboration of Monash University, Xi'an Jiaotong University, China, The University of Hong Kong and World Health Organization, Western Pacific.

Reference

Su S, Wong WC, Zou Z, Cheng DD, Ong JJ, Chan P, Ji F, Yuen MF, Zhuang G, Seto WK, Zhang L. Cost-effectiveness of universal screening for chronic hepatitis B virus infection in China: an economic evaluation. Lancet Glob Health. 2022 Feb;10(2):e278-e287. doi: 10.1016/S2214-109X(21)00517-9. PMID: 35063115; PMCID: PMC8789560.

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