Development and Validation of a Markov Model for the Evaluation of a One-Time Universal Screening for Hepatitis B in Adults

OBJECTIVES: In 2023, the Centers for Disease Control and Prevention (CDC) updated the selective 2008 recommendations for hepatitis B (HBV) screening and testing to include screening all adults aged ≥18 years at least once in their lifetime. This research will describe and validate a Markov model assessing the cost and population health impact of universal screening for HBV in the United States (US).

METHODS: A Markov model was developed with a lifetime horizon to calculate the impact of universal screening, or a one-time HBV screening in all adults aged 18 to 69 years, compared to 2008 CDC recommendations. The prevalence of HBV in the US was based on NHANES data that reported HBV prevalence of 0.36% for adults ≥18 years, 58% male, 33% currently screened for their infection, and 18% of diagnosed patients treated. Prevalence, baseline characteristics, and treatment were assumed to be similar in the universally screened population. Disease transition and death rates were obtained from published data. The transition probability between health states was dependent on treatment, age, and gender, and was applied in 1-year cycles until the patient turned 70 years or died. Costs include screening, monitoring, treatment, and disease management costs adjusted to 2023 dollars.

RESULTS: In a hypothetical cohort of 100,000 patients, universal screening would decrease compensated/decompensated cirrhosis, hepatocellular carcinoma, liver transplants, and HBV-related deaths, by 12%, 13%, 11%, 11% and 10% respectively compared to 2008 CDC recommendations. However, universal screening would incur an additional $4.2 million per 100,000 screened.

CONCLUSIONS: Universal screening of adults aged 18 to 69 years in the US for HBV may lead to better health outcomes compared with 2008 CDC recommendations, however, universal screening would incur additional costs to the healthcare system not offset by these better outcomes. Future research on additional high-risk groups to target may lead to reduced costs.