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Cost-Effectiveness of Hepatitis B Testing and Vaccination of Adults Seeking Care for Sexually Transmitted Infections. Sexually transmitted diseases Hutton, D., Toy, M., Salomon, J. A., Conners, E. E., Nelson, N. P., Harris, A. M., So, S. 2022

Abstract

BACKGROUND: The estimated number of people living with hepatitis B virus (HBV) infection acquired through sexual transmission was 103,000 in 2018, with an estimated incidence of 8,300 new cases per year. While hepatitis B (HepB) vaccination is recommended by the Advisory Committee for Immunization Practices for persons seeking evaluation and treatment for sexually transmitted infections (STI), pre-vaccination testing is not yet recommended. Screening may link persons with chronic hepatitis B (CHB) to care and reduce unnecessary vaccination.METHODS: We used a Markov model to calculate the health impact, and cost-effectiveness of one-time HBV testing combined with the first dose of the hepatitis B vaccine for adults seeking care for STI. We ran a lifetime, societal perspective analysis for a hypothetical population of 100,000 ages 18-69 years. The disease progression estimates were taken from recent cohort studies and meta-analyses. In the US, an intervention that costs less than $100,000 per quality adjusted life year (QALY) is generally considered cost-effective. The strategies that were compared were: 1) vaccination without HBV screening, 2) vaccination and HBsAg screening, 3) vaccination and screening with HBsAg and anti-HBs, and 4) vaccination and screening with HBsAg, anti-HBs and anti-HBc. Data were obtained from Centers for Medicare and Medicaid services reimbursement, the CDC vaccine price list, and additional cost-effectiveness literature.RESULTS: Compared with current recommendations, the addition of one-time HBV testing is cost saving and would prevent an additional 138 cases of cirrhosis, 47 cases of decompensated cirrhosis, 90 cases of hepatocellular carcinoma, 33 liver transplants, and 163 HBV-related deaths, and gain 2185 QALYs, per 100,000 adults screened. Screening with the 3-tests panel would save $41.6-$42.7 million /100,000 adults tested compared with $41.5-$42.5 million for the 2-tests panel and $40.2-$40.3 million for HBsAg alone.CONCLUSIONS: One-time HBV pre-vaccination testing in addition to HepB vaccination for unvaccinated adults seeking care for STI would save lives, prevent new infections and unnecessary vaccination, and is cost saving.

View details for DOI 10.1097/OLQ.0000000000001632

View details for PubMedID 35312661