Background: Despite the high burden of hepatitis B virus (HBV)
infection in sub-Saharan Africa (SSA), a lack of access to widespread
screening or treatment leads to most people remaining undiagnosed until
later stages of disease when prognosis is poor and treatment options are
limited. We evaluated the cost-effectiveness of community-based screening
and early treatment with antiviral therapy for HBV in The Gambia.
Methods: An economic evaluation comparing adult community-based screening
using a Hepatitis B surface antigen (HBsAg) rapid test and subsequent HBV
antiviral therapy to a status quo scenario, where no treatment is
available, was performed by combining a decision tree with a Markov state
transition model. This was parameterised with primary screening and cost
data from the PROLIFICA study. A health provider perspective was taken
and costs and health outcomes were discounted at 3% per annum.
Findings: In The Gambia, where the HBsAg prevalence is 8.8% among those
aged over 30 years old, adult screening and treatment for HBV, has an
Incremental Cost-Effectiveness Ratio (ICER) of $540 per Disability
Adjusted Life Year (DALY) averted, $645 per Life Year (LY) saved and $511
per Quality Adjusted Life Year (QALY) gained, compared to status quo.
These ICERs are in line with willingness-to-pay levels of one times the
country's Gross Domestic Product (GDP) per capita ($487) per DALY
averted, whilst remaining robust, over a wide range of epidemiological
and cost parameters.
Interpretation: Adult community-based screening and treatment for HBV in
the Gambia is likely to be a cost-effective intervention with an ICER
that is comparable with those of HIV screening and treatment
interventions in SSA. Even higher cost-effectiveness, may be achievable
with targeted facility-based screening, price reductions of drug and
diagnostics and integration of HBV screening with other public health
interventions.