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Cost-effectiveness of different monitoring strategies in a screening and treatment programme for hepatitis B in The Gambia

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Title: Cost-effectiveness of different monitoring strategies in a screening and treatment programme for hepatitis B in The Gambia
Authors: Schmit, N
Nayagam, A
Lemoine, M
Ndow, G
Shimakawa, Y
Thursz, M
Hallett, T
Item Type: Journal Article
Abstract: Background: Clinical management of chronic hepatitis B virus (HBV) infection is complex and access to antiviral treatment remains limited in sub-Saharan Africa. International guidelines recommend monitoring at least annually for disease progression among HBV-infected people not meeting treatment criteria at initial diagnosis. This study aimed to assess the impact and cost-effectiveness of alternative strategies for monitoring. Methods: We used a mathematical model of HBV transmission and natural history, calibrated to all available West African data, to project the population-level health impact, costs and cost-effectiveness of different monitoring strategies for HBV-infected individuals not initially eligible for antiviral treatment. We assumed that these patients were found in the year 2020 in a hypothetical community-based screening programme in The Gambia. Monitoring frequencies were varied between every 5 and every 1 year and targeted different age groups. Results: The currently recommended annual monitoring frequency was likely to be not cost-effective in comparison with other strategies in this setting. 5-yearly monitoring in 15-45-year olds, at US$338 per disability-adjusted life year averted, had the highest probability of being the most effective cost-effective monitoring strategy. Conclusions: Monitoring less frequently than once a year is a cost-effective strategy in a community-based HBV screening and treatment programme in The Gambia, with the optimal strategy depending on the cost-effectiveness threshold. Efficiencies may be gained by prioritising the 15-45-year age group for more intensive monitoring.
Issue Date: 20-Jan-2023
Date of Acceptance: 28-Nov-2022
URI: http://hdl.handle.net/10044/1/102023
DOI: 10.7189/jogh.13.04004
ISSN: 2047-2978
Publisher: Edinburgh University Global Health Society
Start Page: 1
End Page: 11
Journal / Book Title: Journal of Global Health
Volume: 13
Copyright Statement: © 2023 The Author(s). This work is licensed under a Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
Publication Status: Published
Online Publication Date: 2023-01-20
Appears in Collections:Department of Metabolism, Digestion and Reproduction
Department of Infectious Diseases
Faculty of Medicine
School of Public Health

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