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

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  • Carmine Rossi
  • Kevin Schwartzman
  • Olivia Oxlade
  • Marina B Klein
  • Chris Greenaway

Abstract

Background: 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. Methods and findings: 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

Suggested Citation

  • Carmine Rossi & Kevin Schwartzman & Olivia Oxlade & Marina B Klein & Chris Greenaway, 2013. "Hepatitis B Screening and Vaccination Strategies for Newly Arrived Adult Canadian Immigrants and Refugees: A Cost-Effectiveness Analysis," PLOS ONE, Public Library of Science, vol. 8(10), pages 1-1, October.
    • Handle: RePEc:plo:pone00:0078548
    DOI: 10.1371/journal.pone.0078548
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    References listed on IDEAS

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    1. Drummond, Michael F. & Sculpher, Mark J. & Torrance, George W. & O'Brien, Bernie J. & Stoddart, Greg L., 2005. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 3, number 9780198529453.
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    1. Claudia Geue & Olivia Wu & Yiqiao Xin & Robert Heggie & Sharon Hutchinson & Natasha K Martin & Elisabeth Fenwick & David Goldberg & Consortium and ECDC, 2015. "Cost-Effectiveness of HBV and HCV Screening Strategies – A Systematic Review of Existing Modelling Techniques," PLOS ONE, Public Library of Science, vol. 10(12), pages 1-26, December.
    2. Carla Osiowy & Elizabeth Giles & Max Trubnikov & Yogesh Choudhri & Anton Andonov, 2015. "Characterization of Acute and Chronic Hepatitis B Virus Genotypes in Canada," PLOS ONE, Public Library of Science, vol. 10(9), pages 1-20, September.
    3. Anita W M Suijkerbuijk & Albert Jan van Hoek & Jelle Koopsen & Robert A de Man & Marie-Josee J Mangen & Hester E de Melker & Johan J Polder & G Ardine de Wit & Irene K Veldhuijzen, 2018. "Cost-effectiveness of screening for chronic hepatitis B and C among migrant populations in a low endemic country," PLOS ONE, Public Library of Science, vol. 13(11), pages 1-16, November.

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