Enhancing the hepatitis B care cascade in Australia: A cost‐effectiveness model

• Published in: Journal of viral hepatitis 2020-05, Vol.27 (5), p.526-536
• Main Authors: Xiao, Yinzong, Howell, Jessica, Gemert, Caroline, Thompson, Alexander J., Seaman, Christopher P., McCulloch, Karen, Scott, Nick, Hellard, Margaret E.
• Format: Article
• Language: English
• Subjects: care cascade; cost‐effectiveness analysis; Diagnosis; Hepatitis; Hepatitis B; Markov chains; Public health; Sensitivity analysis
• ISSN: 1352-0504; 1365-2893
• DOI: 10.1111/jvh.13252

If Australia is to successfully eliminate hepatitis B as a public health threat, it will need to enhance the chronic hepatitis B (CHB) care cascade. This study used a Markov model to assess the impact, cost and cost‐effectiveness of scaling up CHB diagnosis, linkage to care and treatment to reach national and international elimination targets for hepatitis B in Australia. Compared to continued current trends, the model calculated the difference in care cascade projection, disability‐adjusted life years (DALYs), costs and the incremental cost‐effectiveness ratio (ICER), of scaling up CHB diagnosis, linkage to care and treatment to reach: (a) Australia's 2022 national targets and (b) the WHO’s 2030 global targets. Achieving the national and WHO targets had ICERs of A$13 435 (A$10 236‐A$21 165) and A$14 482 (A$13 031‐A$25 641) per DALY averted between 2016 and 2030 in Australia, respectively. However, this excluded implementation and demand generation costs. The ICER for the National Strategy and WHO Strategy remained under A$50 000 per DALY averted if Australia spent up to A$328 or A$538 million, respectively, per annum (for 2016‐2030) on implementation and demand generation activities. Sensitivity analysis showed that cost‐effectiveness was predominately driven by the cost of CHB treatment and influenced by disease progression rates. Hence for Australia to reach the National Hepatitis B Strategy 2022 targets and WHO Strategy 2030 targets, it requires an improvement in the CHB care cascade. We estimated it is cost‐effective to spend up to A$328 million or A$538 million per year to reach the National and WHO Strategy targets, respectively.