Presentation (CTI)

OBJECTIVES: Hepatitis D virus (HDV) infection disproportionately affects immigrant populations in many high-income countries and is associated with accelerated progression to cirrhosis, hepatocellular carcinoma, and liver related mortality. Despite this burden, routine HDV screening remains limited. This study aims to evaluate the cost-effectiveness of screening and treating HDV among chronic hepatitis B (CHB) positive immigrants compared with no screening, incorporating updated treatment efficacy from network meta-analysis.
METHODS: A cost utility analysis was conducted using a validated state-transition model comprising 21 health states to represent the natural history of CHB and HDV superinfection. The analysis adopted a Canadian public payer perspective over a lifetime horizon with costs and outcomes discounted at 1.5% annually. Four strategies were evaluated: no screening, pegylated interferon alfa-2a (PEG-IFN) monotherapy, bulevirtide (BLV) monotherapy, and combination therapy (PEG-IFN and BLV). Treatment efficacy was informed by a network meta-analysis, while costs, utilities, and transition probabilities were obtained from published literature. Outcomes included costs, quality adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). Deterministic and probabilistic sensitivity analyses were conducted.
RESULTS: All strategies improved health outcomes versus no screening. Screening strategies reduced decompensated cirrhosis, hepatocellular carcinoma, and liver-related deaths. PEG-IFN yielded 23.044 QALYs at a total cost of $286,859, with an ICER of $23,177/QALY and was the only cost-effective option at conventional thresholds. BLV monotherapy and combination therapy produced slightly higher QALYs (23.052 and 23.073) but substantially higher costs, with ICERs of $220,112/QALY and $166,181/QALY, respectively. Results were robust, with treatment costs and health state utilities identified as key drivers.
CONCLUSIONS: Screening and treatment of HDV among immigrant populations provide meaningful clinical benefits. PEG-IFN is cost-effective, whereas bulevirtide-based strategies are unlikely to be cost-effective. Although conducted from a Canadian public payer perspective, these findings are generalizable to other high-income immigrant receiving countries with similar epidemiological and healthcare system characteristics.