Valutazione costo-efficacia del percorso dei pazienti a rischio di epatite B sottoposti a test anti-HBV

Background: Currently, guidelines for the management of hepatitis B virus (HBV) infection recommend using the vaccine; however the screening test among not vaccinated people seems to be useful to identify people with clear presence of the virus without disease symptoms. Thanks to the screening test, people infected with HBV are administered conventional therapy in order to stop the progression to cirrhosis, liver failure and hepatocellular carcinoma (HCC). These diseases cause a decrease of QoL and a high consumption of resources for the health system. Objective: Our aim was to assess whether the test approach plus treatment of HBVpositive people is cost-effective in comparison to the no-test approach plus treatment of individuals progressed to cirrhosis or HCC. Methods: We created a Markov model following the natural history of disease and taking into account the antigen HBeAg status to evaluate the cost-effectiveness of the two strategies. The analysis was conducted from a third-party payer perspective. The time horizon considered was 40 cycles of 1 year. Patients positive to the test were administered either with interferon treatment; or lamivudine or adefovir or entecavir or tenofovir, according to Italian guidelines. Patients included in the notest arm were administered treatments after cirrhosis symptoms or HCC. Results: Results of the base case analysis show that patients treated with the test strategy compared with patients of the no-test approach cost each 17,179 euros/QALY. A Montecarlo simulation based on a probabilistic sensitivity analysis points out that, in 95% of cases outlined in the 1000 scenarios assumed, the cost per QALY would be below an hypothetic threshold of 40,000 euros. Conclusion: The anti-HBV test can be highly recommended in all categories at high risk of HBV.