Cost effectiveness of screening immigrants for hepatitis B

Liver Int. 2011 Sep;31(8):1179-90. doi: 10.1111/j.1478-3231.2011.02559.x. Epub 2011 Jun 14.


Background: The prevalence of chronic hepatitis B (CHB) infection among the immigrants of North America ranges from 2 to 15%, among whom 40% develop advanced liver disease. Screening for hepatitis B surface antigen is not recommended for immigrants.

Aims: The objective of this study is to estimate the health and economic effects of screening strategies for CHB among immigrants.

Methods: We used the Markov model to examine the cost-effectiveness of three screening strategies: (i) 'No screening'; (ii) 'Screen and Treat' and (iii) 'Screen, Treat and Vaccinate' for 20-65 years old individuals who were born abroad but are currently living in Canada. Model data were obtained from the published literature. We measured predicted hepatitis B virus (HBV)-related deaths, costs (2008 Canadian Dollars), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER).

Results: Our results show that screening all immigrants will prevent 59 HBV-related deaths per 10, 000 persons screened over the lifetime of the cohort. Screening was associated with an increase in quality-adjusted life expectancy (0.024 QALYs) and cost ($1665) per person with an ICER of $69, 209/QALY gained compared with 'No screening'. The 'Screen, Treat and Vaccinate' costs an additional $81, generates an additional 0.000022 QALYs per person, with an ICER of $3, 648,123/QALY compared with the 'Screen and Treat'. Sensitivity analyses suggested that the 'Screen and Treat' is likely to be moderately cost-effective.

Conclusion: We show that a selective hepatitis B screening programme targeted at all immigrants in Canada is likely to be moderately cost-effective. Identification of silent CHB infection with the offer of treatment when appropriate can extend the lives of immigrants at reasonable cost.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antiviral Agents / economics
  • Antiviral Agents / therapeutic use
  • Canada / epidemiology
  • Cost-Benefit Analysis
  • Emigrants and Immigrants*
  • Health Care Costs*
  • Hepatitis B Vaccines / economics
  • Hepatitis B, Chronic / diagnosis*
  • Hepatitis B, Chronic / economics*
  • Hepatitis B, Chronic / mortality
  • Hepatitis B, Chronic / prevention & control
  • Hepatitis B, Chronic / therapy
  • Humans
  • Liver Transplantation / economics
  • Markov Chains
  • Mass Screening / economics*
  • Middle Aged
  • Models, Economic
  • Predictive Value of Tests
  • Prevalence
  • Quality-Adjusted Life Years
  • Young Adult


  • Antiviral Agents
  • Hepatitis B Vaccines