The Economic Value of Diagnostic Strategies in Hepatitis D: A Methodological Review of Cost-Effectiveness Models
Author(s)
Tushar Srivastava, MSc1, Devian Parra-Padilla, MSc1, R Lakshmi, MSc2, Saeed Anwar, MPharm2, Raju Gautam, PhD1, James Karichu, BSc, MPH, PhD3, Thaison Tong, PhD1.
1ConnectHEOR, London, United Kingdom, 2ConnectHEOR, Delhi, India, 3Roche Molecular Systems, Pleasanton, CA, USA.
1ConnectHEOR, London, United Kingdom, 2ConnectHEOR, Delhi, India, 3Roche Molecular Systems, Pleasanton, CA, USA.
OBJECTIVES: Hepatitis D virus (HDV) infection affects individuals with hepatitis B (HBV) and is associated with more severe liver-related problems. As testing strategies for HDV evolve, understanding their economic value is imperative to inform policy and resource allocation. This study aimed to assess the current evidence on the cost-effectiveness of HDV diagnostic strategies and identify key methodological considerations.
METHODS: A targeted literature review was conducted in PubMed (from inception to April 21, 2025), supplemented by a grey literature search. Modeling studies that assessed the economic value of diagnostic approaches for HDV were included. We extracted data on population, perspective, time horizon, model structure, diagnostic algorithms, and key outcomes.
RESULTS: Our search identified 108 unique records, of which two met the inclusion criteria. Two additional studies were included from grey literature search. Total four studies were included. Two studies were from Spain (50%), and one each (25%) from the USA and UK. All studies focused on individuals with HBV infection without risk stratification. The modeling approaches were decision tree (50%) and hybrid decision tree-Markov models (50%). Considerable heterogeneity was observed in model structures, diagnostic pathways, and downstream clinical assumptions post-testing. The studies using Markov models employed lifetime horizons. Three studies (75%) used a healthcare system perspective. Two studies compared distinct screening scenarios: universal (100%) vs status quo (12.9% and 7.6%). Only one study included alanine aminotransferase testing in the decision tree structure. The Markov models varied in health states reflecting liver disease progression before compensated or decompensated cirrhosis. Only one study explicitly modelled HBV infection status change. Results were highly sensitive to HDV prevalence, treatment eligibility, and costs.
CONCLUSIONS: Existing modeling studies provide insights, but methodological variability hinders comparisons. Future studies should standardize methods while allowing flexible evaluation of HDV screening across settings to support policy decisions.
METHODS: A targeted literature review was conducted in PubMed (from inception to April 21, 2025), supplemented by a grey literature search. Modeling studies that assessed the economic value of diagnostic approaches for HDV were included. We extracted data on population, perspective, time horizon, model structure, diagnostic algorithms, and key outcomes.
RESULTS: Our search identified 108 unique records, of which two met the inclusion criteria. Two additional studies were included from grey literature search. Total four studies were included. Two studies were from Spain (50%), and one each (25%) from the USA and UK. All studies focused on individuals with HBV infection without risk stratification. The modeling approaches were decision tree (50%) and hybrid decision tree-Markov models (50%). Considerable heterogeneity was observed in model structures, diagnostic pathways, and downstream clinical assumptions post-testing. The studies using Markov models employed lifetime horizons. Three studies (75%) used a healthcare system perspective. Two studies compared distinct screening scenarios: universal (100%) vs status quo (12.9% and 7.6%). Only one study included alanine aminotransferase testing in the decision tree structure. The Markov models varied in health states reflecting liver disease progression before compensated or decompensated cirrhosis. Only one study explicitly modelled HBV infection status change. Results were highly sensitive to HDV prevalence, treatment eligibility, and costs.
CONCLUSIONS: Existing modeling studies provide insights, but methodological variability hinders comparisons. Future studies should standardize methods while allowing flexible evaluation of HDV screening across settings to support policy decisions.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE706
Topic
Economic Evaluation
Disease
Infectious Disease (non-vaccine)