Cost-effectiveness of screening and vaccinating Asian and Pacific Islander adults for hepatitis B

ArticleinAnnals of internal medicine 147(7):460-9 · November 2007with19 Reads
Source: PubMed
As many as 10% of Asian and Pacific Islander adults in the United States are chronically infected with hepatitis B virus (HBV), and up to two thirds are unaware that they are infected. Without proper medical management and antiviral therapy, up to 25% of Asian and Pacific Islander persons with chronic HBV infection will die of liver disease. To assess the cost-effectiveness of 4 HBV screening and vaccination programs for Asian and Pacific Islander adults in the United States. Markov model with costs and benefits discounted at 3%. Published literature and expert opinion. Asian and Pacific Islander adults (base-case age, 40 years; sensitivity analysis conducted on ages 20 to 60 years). Lifetime. U.S. societal. A universal vaccination strategy in which all individuals are given a 3-dose vaccination series; a screen-and-treat strategy, in which individuals are given blood tests to determine whether they are chronically infected, and infected persons are monitored and treated; a screen, treat, and ring vaccinate strategy, in which all individuals are tested for chronic HBV infection and close contacts of infected persons are screened and vaccinated if needed; and a screen, treat, and vaccinate strategy, in which all individuals are tested and then vaccinated with a 3-dose series if needed. In all cases, persons found to be chronically infected are monitored and treated if indicated. Costs (2006 U.S. dollars), quality-adjusted life-years (QALYs), and incremental cost-effectiveness. Compared with the status quo, the screen-and-treat strategy has an incremental cost-effectiveness ratio of $36,088 per QALY gained. The screen, treat, and ring vaccinate strategy gains more QALYs than the screen and treat strategy and incurs modest incremental costs, leading to incremental cost-effectiveness of $39,903 per QALY gained compared with the screen and treat strategy. The universal vaccination and screen, treat, and vaccinate strategies were weakly dominated by the other 2 strategies. Over a wide range of variables, the incremental cost-effectiveness ratios of the screen and treat and screen, treat, and ring vaccinate strategies were less than $50,000 per QALY gained. Results depend on the accuracy of the underlying data and assumptions. The long-term effectiveness of new and future HBV treatments is uncertain. Screening programs for HBV among Asian and Pacific Islander adults are likely to be cost effective. Clinically significant benefits accrue from identifying chronically infected persons for medical management and vaccinating their close contacts. Such efforts can greatly reduce the burden of HBV-associated liver cancer and chronic liver disease in the Asian and Pacific Islander population.
    • "With a recent immigration wave from Asia, this is the fastest growing ethnic group in the United States [8]. Although vaccination can prevent infection, rates of prevention in Asian Americans have been suboptimal [9, 10] . Secondly , not only are Asian Americans disproportionately affected by chronic hepatitis B (CHB), but they are also most likely of any population group in America to develop HBV-related liver cancer [11, 12]. "
    Article · Dec 2016
    • "While the cost effectiveness of HBV screening among the general population is under debate [5,6], HBV vaccination among foreign born adult immigrants is considered to be vital. A cost-effective analysis comparing several HBV screening and vaccination strategies among Asian and Pacific Islander adults found a screen, treat, and ring vaccination strategy was highly cost effective [7]. In this approach, everyone was screened by hepatitis B surface antigen (HBsAg) tests to determine whether they were chronically infected, and people with close contact with infected individuals were given hepatitis B surface antibody (HBsAb) tests and vaccinated if needed. "
    [Show abstract] [Hide abstract] ABSTRACT: This study aimed to evaluate the effect of a lay health worker (LHW) telephone intervention on completing a series of hepatitis B virus (HBV) vaccinations among foreign-born Asian Americans in the Baltimore-Washington Metropolitan area.
    Full-text · Article · Sep 2016
    • "A recent economic evaluation has analysed several alternative strategies targeting Asian and Pacific Islander adults in the USA, with an integrated approach being one of these strategies (Hutton et al 2007). Against a status quo of voluntary screening only, the four incremental strategies considered were: a) a universal vaccination strategy — all individuals receive 3 doses of vaccine; b) a screen and treat strategy — individuals are tested for chronic HBV infection with those testing positive being referred for treatment; c) a screen, treat and ring vaccinate strategy which is strategy (b) plus screening and vaccination (if needed) of close contacts of those infected; and d) a screen, treat and vaccinate strategy applied to all individuals in the target population. "
    [Show description] [Hide description] DESCRIPTION: Australian Centre for Economic Research on Health, Research Report No.7, September 2009
    File · Research · Apr 2016 · PLoS ONE
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