Economic evaluation of hepatitis B screening in low- and middle-income countries: a systematic review

Hepatitis B virus (HBV) causes significant morbidity and mortality worldwide, particularly in low- and middle-income countries (LMICs) with intermediate to high endemicity. Screening interventions are essential for reducing infection rates.

To synthesize economic evaluation evidence of hepatitis B (HBV) screening strategies in LMICs.

A comprehensive search of PubMed, Embase, and Scopus was conducted up to August 08, 2024. All types of economic evaluations comparing HBV screening strategies in LMICs were included. Study quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 and the Consensus Health Economic Criteria (CHEC) extended checklists. The protocol was registered in PROSPERO (CRD42023472855).

Twenty-four studies were included, with 11 focusing on pregnant women, 7 on adults, and others on children or infants. Most studies were from Asia, primarily China, using model-based analyses and a provider cost perspective. Regarding antenatal screening, adding tenofovir prophylaxis for HBsAg-positive pregnant women was more cost-effective than intervention solely targeting infants. In adults, a combination of screening and treating eligible cases or immunizing non-infected individuals was more cost-effective than no screening, particularly among young adults aged 21 to 39. Notably, expanding HBV screening to the general population was more cost-effective than limiting screening to high-risk groups. In children, screening plus re-vaccination of infants or 10-year-olds born to HBV-infected mothers was cost-effective compared to no re-vaccination.

Overall, more comprehensive interventions were generally cost-effective across all populations. The most cost-effective strategies included tenofovir prophylaxis for HBV-infected pregnant women, screening with treatment and/or vaccination in adults, and screening combined with re-vaccination in children.