A cost-consequence analysis of screening and treatment for chronic hepatitis B (CHB) virus infection in resident immigrants of an Italian North-East

Introduction: The epidemiology of hepatitis B in Europe is changing, with migration causing significant increases in prevalence rates. It is of paramount importance to identify the most effective ways to contain the disease. Systematic screening and treatment of migrants for CHB virus infection is likely to be costeffective, but it is crucial to take into account the significant associated costs and the considerable net investment by governments. Aim: The objective of this study is to estimate the health and economic effects of screening strategy for CHB screening among immigrants. Materials and methods: We used the Markow model to examine the cost-consequence of screening and treatment vs a no screening strategy in a cohort of 348,991 adult migrants resident in the Veneto Region. The rate of adherence to the HBV screening program was judged to be 40%. The prevalence of HBV infection (6.03%) and the chance of having active CHB (30%) were based on our recent screening campaign in Padua involving 465 migrants. Likelihood of HBV-related events was obtained from literature. Results: The screening-treatment strategy prevented 273 cases of cirrhosis, 18 decompensated cirrhosis, 28 HCC, and 54 CHB related deaths, over a period of 5 years. The incremental cost of the screening strategy totaled 51,597,980 D in five years (0.1% of the Veneto annual health budget). Conclusions: This study provides information useful mainly to policy makers, who need to establish whether the cost generated by a screening strategy is affordable when set against the better health outcomes for resident immigrants.