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Abstract Details
Universal testing for hepatitis B and hepatitis C in the emergency department: a cost-effectiveness and budget impact analysis of two urban hospitals in the United Kingdom
Cost Eff Resour Alloc. 2022 Nov 14;20(1):60. doi: 10.1186/s12962-022-00388-7.
1Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock place, London, WC1H 9SH, UK. Jack.Williams@lshtm.ac.uk.
2The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College, London, UK. Jack.Williams@lshtm.ac.uk.
3Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK.
4The NIHR HPRU in Behavioural Science and Evaluation at the University of Bristol, Bristol, UK.
5UK Field Epidemiology Training Programme, UK Health Security Agency, Leeds, UK.
7Department of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK.
8Emergency Department, Guy's and St Thomas' NHS Foundation Trust, London, UK.
9Public Health-Medical Department, Gilead Sciences Ltd UK and Ireland, London, UK.
10Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock place, London, WC1H 9SH, UK.
11The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College, London, UK.
Abstract
Background: Numerous studies have shown the effectiveness of testing for hepatitis B (HBV) and hepatitis C (HCV) in emergency departments (ED), due to the elevated prevalence amongst attendees. The aim of this study was to conduct a cost-effectiveness analysis of universal opt-out HBV and HCV testing in EDs based on 2 long-term studies of the real-world effectiveness of testing in 2 large ED's in the UK.
Methods: A Markov model was used to evaluate ED-based HBV and HCV testing versus no ED testing, in addition to current testing practice. The two EDs had a HBV HBsAg prevalence of 0.5-0.9% and an HCV RNA prevalence of 0.9-1.0%. The analysis was performed from a UK health service perspective, over a lifetime time horizon. Costs are reported in British pounds (GBP), and outcomes as quality adjusted life years (QALYs), with both discounted at 3.5% per year. Incremental cost-effectiveness ratios (ICER) are calculated as costs per QALY gained. A willingness-to-pay threshold of £20,000/QALY was used. The cost-effectiveness was estimated for both infections, in both ED's.
Results: HBV and HCV testing were highly cost-effective in both settings, with ICERs ranging from £7,177 to £12,387 per QALY gained. In probabilistic analyses, HBV testing was 89-94% likely to be cost-effective at the threshold, while HCV testing was 94-100% likely to be cost-effective, across both settings. In deterministic sensitivity analyses, testing remained cost-effective in both locations at ≥ 0.25% HBsAg prevalence, and ≥ 0.49% HCV RNA prevalence. This is much lower than the prevalence observed in the two EDs included in this study.
Conclusions: HBV and HCV testing in urban EDs is highly cost-effective in the UK, and can be cost-effective at relatively low prevalence. These results should be reflected in UK and European hepatitis testing guidelines.