Background: Many people living with chronic HBV infection remain undiagnosed until later stages of disease.
Increasing testing and treatment rates form part of the strategy to respond to the WHO goal of eliminating viral
hepatitis as a public health threat by 2030. However, achieving these ambitious targets is dependent on finding
effective and cost-effective methods of scale up strategies. The aim of this study was to undertake a narrative
review of the literature on economic evaluations of testing and treatment for HBV infection, to help inform the
development of the 2017 WHO Hepatitis Testing Guidelines.
Methods: We undertook a focussed literature review for economic evaluations on testing for HBV accompanied by
antiviral treatment. The search was carried out in Pubmed and included only articles published after 2000 and written
in English. We narratively synthesise the results and discuss the key drivers of cost-effectiveness and their applicability
to low and middle-income countries (LMICs).
Results: Nine published studies were included in this review, only one of which was performed in a low or middleincome
setting in West Africa. Eight studies were performed in high-income settings, seven among high risk groups
and one among the general population. The studies were heterogeneous in many respects including the population
and testing strategy under consideration, model structure and baselines parameters, willingness to pay thresholds and
outcome measures used. However, most studies found HBV testing and treatment to be cost-effective, even at low
HBsAg prevalence levels.
Conclusions: Currently economic evaluations of HBV testing and treatment strategies in LMICs is lacking, therefore
limiting the ability to provide formal recommendations on the basis of cost-effectiveness alone. Further implementation
research is needed in order to help guide national policy planning.