Carmine Rossi, Kevin Schwartzman Olivia Oxlade

Publication date:
10-01-2013

Last Reviewed: 10-31-2013

Hepatitis B Screening and Vaccination Strategies for Newly Arrived Adult Canadian Immigrants and Refugees: A Cost-Effectiveness Analysis


Source: PLOS ONE| Volume 8 | Issue 10

Summary:
This study compares four HBV screening and vaccination strategies with no intervention in a hypothetical cohort of newly-arriving adult Canadian immigrants.

Immigrants have increased mortality from hepatocellular carcinoma as compared to the host populations, primarily due to undetected chronic hepatitis B virus (HBV) infection. Despite this, there are no systematic programs in most immigrant-receiving countries to screen for chronic HBV infection and immigrants are not routinely offered HBV vaccination outside of the universal childhood vaccination program.
A cost-effective analysis was performed to compare four HBV screening and vaccination
strategies with no intervention in a hypothetical cohort of newly-arriving adult Canadian immigrants. The strategies
considered were a) universal vaccination, b) screening for prior immunity and vaccination, c) chronic HBV screening
and treatment, and d) combined screening for chronic HBV and prior immunity, treatment and vaccination. The
analysis was performed from a societal perspective, using a Markov model. Seroprevalence estimates, annual
transition probabilities, health-care costs (in Canadian dollars), and utilities were obtained from the published
literature. Acute HBV infection, mortality from chronic HBV, quality-adjusted life years (QALYs), and costs were
modeled over the lifetime of the cohort of immigrants. Costs and QALYs were discounted at a rate of 3% per year.
Screening for chronic HBV infection, and offering treatment if indicated, was found to be the most cost-effective
intervention and was estimated to cost $40,880 per additional QALY gained, relative to no intervention. This strategy
was most cost-effective for immigrants < 55 years of age and would cost < $50,000 per additional QALY gained for
immigrants from areas where HBV seroprevalence is ≥ 3%. Strategies that included HBV vaccination were either
prohibitively expensive or dominated by the chronic HBV screening strategy.
Conclusions: Screening for chronic HBV infection from regions where most Canadian immigrants originate, except
for Latin America and the Middle East, was found to be reasonably cost-effective and has the potential to reduce
HBV-associated morbidity and mortality.



Link 1: http://www.plosone.org/article/fetchObject.action?uri=info%3Adoi%2F10.1371%2Fjournal.pone.0078548&representation=PDF

Theme: Health and Well Being

Region: Canada

Subject Group: Immigrants, Refugees, Adults