Universal HDV screening in patients with HBV appears cost-effective

One-time hepatitis D virus (HDV) testing for all hepatitis B surface antigen (HBsAg)-positive adults and treatment of chronic HDV infection with pegylated interferon (PEG-IFN) is a potentially cost-effective intervention in the United States, a study found.

Researchers used a Markov model to calculate the costs, health impact, and cost-effectiveness of universal testing of adults with chronic hepatitis B virus (HBV) infection with an HDV antibody test and, if positive, an HDV RNA test to detect chronic infection. Investigators assumed half of the HDV RNA-positive patients would receive the current recommended treatment with PEG-IFN for 48 weeks and that there would be a 30% response rate.

To determine if the interventions were cost-effective, they modeled the potential impact of hypothetical indefinite HDV antiviral therapy with a higher response rate to assess the annual cost threshold. The hypothetical cohort of diagnosed HBsAg-positive patients started from age 45 years. Outcomes of the universal one-time testing strategy were compared with the status quo, that is, 12.9% of adults with chronic HBV infection in the U.S. screened for HDV. Findings were published by Clinical Infectious Diseases on April 8.

Universal HDV testing of adults with chronic hepatitis B could avert 100 HDV-related deaths, an additional 30 cases of cirrhosis, and 50 cases of hepatocellular carcinoma per 100,000 HBsAg-positive individuals screened. It could also potentially result in a gain of 1,500 quality-adjusted life-years (QALYs) per 100,000 individuals screened. With a willingness-to-pay threshold of $50,000 per QALY, the annual drug costs for a hypothetical indefinite therapy with a 50% or 70% treatment response rate would need to cost $13,027 and $14,104 or less, respectively. Compared with the status quo, universal testing and treatment of HDV has an incremental cost-effectiveness ratio of $22,333 per QALY, resulting in an averted $33.5 million in lifetime health care costs to treat HDV-related liver complications per 100,000 HBsAg-positive individuals screened.

Limitations to the study include that disease progression rates in patients with chronic HDV are based on estimates from available published studies. The researchers also assumed 50% of the HDV RNA-positive adults would not receive treatment because of normal alanine aminotransferase levels or decompensated cirrhosis. The study did not include patients' out-of-pocket costs.

“Since many HBV infected individuals are unaware of their infection, there is a missed opportunity for significant improvements, including the diagnosis of HDV infections, if HBV infection ascertainment is not achieved. The potential benefits are substantial if more individuals become aware of their HBV status,” the authors wrote.