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HBV Screening

HBV Screening. Stewart Cooper MD Chief, Division of Hepatology California Pacific Medical Center. Cost-Effectiveness of Screening and Vaccinating Asian and Pacific Islander Adults for Hepatitis B David W. Hutton, MS; Daniel Tan, MS; Samuel K. So, MD; and Margaret L. Brandeau, PhD

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HBV Screening

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  1. HBV Screening Stewart Cooper MD Chief, Division of Hepatology California Pacific Medical Center

  2. Cost-Effectiveness of Screening and Vaccinating Asian and Pacific Islander Adults for Hepatitis B • David W. Hutton, MS; Daniel Tan, MS; Samuel K. So, MD; and Margaret L. Brandeau, PhD • Ann Intern Med. 2007;147:460-469. • FINDINGS • Compared with the status quo, the screen-and-treat strategy has an incremental cost-effectiveness ratio of $36, 088 per QALY gained. The screen, treat, and vaccinate strategy gains more QALYs than the screen and treat strategy and incurs modest incremental costs, leading to incremental cost-effectiveness of $39, 903 per QALY gained compared with the screen and treat strategy#. • Screening programs for HBV among Asian and Pacific Islander adults are likely to be cost effective. Clinically significant benefits accrue from identifying chronically infected persons for medical management and vaccinating their close contacts. Such efforts can greatly reduce the burden of HBV-associated liver cancer and chronic liver disease in the Asian and Pacific Islander population. # Medical interventions that cost less than $50 000 per QALY gained are broadly considered acceptable

  3. HBV Screening in Asians and Pacific Islanders: Interim Cost-effectiveness Analysis of a Single-center San Francisco Program • Michele Tana1, Kaveh Hoda2,3,5, David Hutton4, Jackson Wong2, Charlotte Ma2, Yiqiu Wei2, Wylie Liu2, Nanette Hinojales8, Paula Lykins5, Germaine Andres8, David Stone5, Doug Wong2,5, Grace Estevez2, Eddie Cheung2,3,7, Judy Li10, Robert Gish2,5 Stewart Cooper2,5,§ • Manuscript Submitted. • Objective: This study reports the results of a single center’s contribution to SF Hep B Free and uses a published Markov framework to examine actual cost-effectiveness of HBV assessment in: all API, first- and second-generation API, and first-generation API only (N = 1885) • Design: Retrospective analysis of all persons screened and vaccinated over a 14-month period, plus integration of data from the SF Hep B Free program into the Markov framework. • Setting: Multiple screening events sponsored by a single center in San Francisco. • Subjects: Asian and Pacific Islanders screened for HBV during the study period. • Results: Compared to the status quo (no intervention), a screening and vaccination strategy in all API yielded an incremental cost-effectiveness ratio (ICER) higher than for solely targeting first-generation API, or first- and second-generation API only. All strategies had ICERs below the threshold generally regarded as cost-effective. • Comprehensive HBV screening initiatives that target all API regardless of generation status are likely cost-effective, despite lower HBV prevalence in second- and third-generations.

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