• Yinzong Xiao, Margaret E Hellard, Alexander J Thompson, Christopher Seaman, Jess Howell, and Nick Scott.
• The Burnet Institute, Melbourne, VIC.
• Med. J. Aust. 2023 Mar 6; 218 (4): 168173168-173.

ObjectivesTo assess the impact on diagnosis targets, cost, and cost-effectiveness of universal hepatitis B screening in Australia.DesignMarkov model simulation of disease and care cascade progression for people with chronic hepatitis B in Australia.SettingThree scenarios were compared: 1. no change to current hepatitis B virus (HBV) testing practice; 2. universal screening strategy, with the aim of achieving the WHO diagnosis target by 2030 (90% of people with chronic hepatitis B diagnosed), based on opportunistic (general practitioner-initiated) screening for HBsAg; 3. universal screening strategy, and also ensuring that 50% of people with chronic hepatitis B are receiving appropriate clinical management by 2030.Main Outcome MeasuresProjected care cascade for people with chronic hepatitis B, cumulative number of HBV-related deaths, intervention costs, and health utility (quality-adjusted life-years [QALYs] gained during 2020-2030). An incremental cost-effectiveness ratio (ICER) threshold (v scenario 1) of $50 000 per QALY gained was applied.ResultsCompared with scenario 1, 80 HBV-related deaths (interquartile range [IQR], 41-127 deaths) were averted during 2020-2030 in scenario 2, 315 HBV-related deaths (IQR, 211-454 deaths) in scenario 3. Scenario 2 cost $84 million (IQR, $41-106 million) more than scenario 1 during 2020-2030 (+8%), yielding an ICER of $104 921 (IQR, $49 587-107 952) per QALY gained. Scenario 3 cost $263 million (IQR, $214-316 million) more than scenario 1 during 2020-2030 (+24%), yielding an ICER of $47 341 (IQR, $32 643-58 200) per QALY gained. Scenario 3 remained cost-effective if the test positivity rate was higher than 0.35% or the additional costs per person tested did not exceed $4.02.ConclusionsUniversal screening for hepatitis B will be cost-effective only if the cost of testing is kept low and people receive appropriate clinical management.© 2023 AMPCo Pty Ltd.

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