The cost-effectiveness of screening for chronic hepatitis B infection in the United States
Open accessAbstract
BACKGROUND: Hepatitis B virus (HBV) continues to cause significant morbidity and mortality in the United States. Current guidelines suggest screening populations with a prevalence of ≥2%. Our objective was to determine whether this screening threshold is cost-effective and whether screening lower-prevalence populations might also be cost-effective. METHODS: We developed a Markov state transition model to examine screening of asymptomatic outpatients in the United States. The base case was a 35-year-old man living in a region with an HBV infection prevalence of 2%. Interventions (versus no screening) included screening for Hepatitis B surface antigen followed by treatment of appropriate patients with (1) pegylated interferon-α2a for 48 weeks, (2) a low-cost nucleoside or nucleotide agent with a high rate of developing viral resistance for 48 weeks, (3) prolonged treatment with low-cost, high-resistance nucleoside or nucleotide, or (4) prolonged treatment with a high-cost nucleoside or nucleotide with a low rate of developing viral resistance. Effectiveness was measured in quality-adjusted life years (QALYs) and costs in 2008 US dollars. RESULTS: Screening followed by treatment with a low-cost, high-resistance nucleoside or nucleotide was cost-effective ($29,230 per QALY). Sensitivity analyses revealed that screening costs <$50,000 per QALY in extremely low-risk populations unless the prevalence of chronic HBV infection is <.3%. CONCLUSIONS: The 2% threshold for prevalence of chronic HBV infection in current Centers for Disease Control and Prevention/US Public Health Service screening guidelines is cost-effective. Furthermore, screening of adults in the United States in lower-prevalence populations (eg, as low as .3%) also is likely to be cost-effective, suggesting that current health policy should be reconsidered.
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Hepatitis B screening in an office setting costs $46 per patient.
“screening for hepatitis B in an office setting is $46 per patient (Eckman, Kaiser, & Sherman, 2011).”
From Monetary conversion factors for economic evaluations of substance use disorders (2017) · cites this paper as Eckman, Kaiser, & Sherman, 2011
The Costs section says screening costs were modeled, but the available Table 2 text does not give a readable per-patient screening price. Searches for “$46,” “office setting,” and screening cost per patient found no passage establishing the claimed amount; the totals in Table 3 include treatment and do not settle it. (LLM, conf=0.72)
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- Authors
- Eckman, M. H., Kaiser, T. E., & Sherman, K. E.
- Affiliations
- University of Cincinnati (US)
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2011-06-01
- Volume
- 52
- Issue
- 11
- Pages
- 1294-1306
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- PMC
- PMC3097367
- OpenAlex
- W4242609773
- Cited by
- 80
- References
- 54
- Citations by year
- 2026: 3 · 2025: 2 · 2023: 2 · 2022: 7 · 2021: 4 · 2020: 3 · 2019: 4 · 2018: 6 · 2017: 10 · 2016: 7 · 2015: 4 · 2014: 6 · 2013: 13 · 2012: 5
- FWCI
- 6.75
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Infectious Diseases (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Gilead Sciences
- Valeant Pharmaceuticals International
- Savient Pharmaceuticals
- Astellas Pharma
- National Institutes of Health (5ul1rr026314-03, UL1TR000077)
- Genentech
- National Heart, Lung, and Blood Institute (K30 HL078581-01)
- National Institute of Diabetes and Digestive and Kidney Diseases (K23DK075599, DK075599, K24DK070528)
- U.S. National Library of Medicine (R01LM009533)
- National Center for Research Resources (1UL1RR026314, UL1-RR026314)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Epidemiology › Hepatitis B Virus Studies
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Hepatology › Hepatitis C virus research
- Keywords
- chronic hepatitis B, hepatitis B virus, screening thresholds, cost-effectiveness, hepatitis B surface antigen, peginterferon alfa-2a, nucleoside analogues, antiviral resistance, quality-adjusted life years, HBV prevalence, screening guidelines
- MeSH terms
- Adult, Antiviral Agents, Cost-Benefit Analysis, Hepatitis B Surface Antigens, Humans, Male, Mass Screening, United States, Models, Statistical, Prevalence, Hepatitis B, Chronic
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