Paper Information

A Markov model was used to calculate the costs, health impact, and cost-effectiveness of universal testing of HBsAg- positive adults with an HDV antibody test and, when positive, an HDV RNA test for chronic HDV infection. We assumed 50% of the HDV RNA positive patients would receive the current recommended treatment with pegylated interferon (PEG-IFN) for 48 weeks. With a 30% response rate. We also modelled the potential impact of hypothetical indefinite HDV antiviral therapy with a higher response rate to assess the annual cost threshold to be considered cost-effective.

Chronic hepatitis D virus (HDV) infection increases the risk of liver-related deaths in adults with chronic hepatitis B (CHB). In the US, only an estimated 12.9% of adults with CHB have received an HDV antibody test. The aim of this study is to calculate the cost-effectiveness of one-time universal HDV testing of hepatitis B surface antigen (HBsAg)-positive adults living in the US.

Universal HDV testing of adults with CHB could avert 100 HDV-related deaths and an additional 30 cases of cirrhosis and 50 cases of hepatocellular carcinoma, and potentially result in a gain of 1,500 QALYs per 100,000 HBsAg-positive individuals screened. At a willingness to pay threshold of $50,000/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, respectively.

One-time HDV testing for all HBsAg-positive adults and treatment of chronic HDV infection with PEG-INF is potentially cost effective in the US.