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A systematic review of hepatitis B screening economic evaluations in low- and middle-income countries


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Wright, CM, Boudarene, L, Ha, NT, Wu, O and Hawkins, N 2018 , 'A systematic review of hepatitis B screening economic evaluations in low- and middle-income countries' , BMC public health, vol. 18, no. 1 , pp. 1-12 , doi: 10.1186/s12889-018-5261-8.

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Background: Chronic hepatitis B infection is a significant cause of morbidity and mortality worldwide; low- andmiddle-income countries (LMICs) are disproportionately affected. Economic evaluations are a useful decision tool toassess costs versus benefits of hepatitis B virus (HBV) screening. No published study reviewing economic evaluationsof HBV screening in LMICs has been undertaken to date.Methods: The following databases were searched from inception to 21 April 2017: MEDLINE, PubMed, EMBASE,CINAHL Plus, the Cochrane Library, Global Health and the Cost-effectiveness Analysis Registry. English-languagestudies were included if they assessed the costs against the benefits of HBV screening in LMICs. PROSPEROregistration: CRD42015024391, 20 July 2015.Results: Nine studies fulfilled the eligibility criteria. One study from Thailand indicated that adding hepatitis Bimmunoglobulin (HBIG) to HBV vaccination for newborns following screening of pregnant women might becost-effective for some LMICs, though inadequate total funding and health infrastructure were likely to limitfeasibility. A similar study from China indicated a benefit to cost ratio of 2.7 from selective HBIG administration tonewborns, if benefits were considered from a societal perspective. Of the two studies assessing screening amongstthe general adult population, a single cost-benefit analysis from China found a benefit to cost ratio (BCR) of 1.73 withvaccination guided by HBV screening of adults aged 21–39, compared to 1.42 with vaccination with no screening,both from a societal perspective. Community-based screening of adults in The Gambia with linkage to treatmentyielded an incremental cost per disability-adjusted life year averted of $566 (in 2017 USD), less than two-times grossdomestic product per capita for that country.Conclusions: Screening with ‘catch-up’ vaccination for younger adults yielded benefits above costs, and screeninglinked with treatment has shown cost-effectiveness that may be affordable for some LMICs. However, interpretationneeds to account for total cost implications and further research in LMICs is warranted as there were only nineincluded studies and evidence from high-income countries is not always directly applicable.

Item Type: Article
Authors/Creators:Wright, CM and Boudarene, L and Ha, NT and Wu, O and Hawkins, N
Keywords: Costs and cost analysis, Hepatitis B, Hepatitis, viral, human, Economics, medical
Journal or Publication Title: BMC public health
Publisher: Biomed Central Ltd
ISSN: 1471-2458
DOI / ID Number: 10.1186/s12889-018-5261-8
Copyright Information:

Copyright 2018 The Authors. Licensed under Creative Commons Attribution 4.0 International (CC BY 4.0)

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