OBJECTIVES: China faces considerable challenges in reducing hepatitis B virus (HBV)-related mortality. This study aimed to evaluate the economic benefits of a comprehensive screening and disease management program conducted in Huazhou City in China (i.e. “the screening program”), which included mass HBV screening for the general population and subsequent HBV management and hepatocellular carcinoma (HCC) screening for HBV patients.

METHODS: A decision-tree and Markov model was developed to compare the cost-effectiveness of the screening program compared to the status quo in Huazhou city. The screening program initially offered a rapid HBsAg test to 104,112 residents. Those with positive results underwent a confirmatory HBV serology panel for diagnosis. Accounting for testing sensitivity and specificity, and those who did not complete confirmatory testing, the total number of HBV-infected patients was estimated to be 9,228. The decision tree model simulated this initial HBV screening process, establishing the initial cohort for the Markov model. The Markov model then simulated disease progression through ten states, summarized broadly as chronic HBV infection, cirrhosis, HCC, and death. The analysis was conducted from a healthcare system perspective over a lifetime horizon with a 3% discount rate. Disease progression parameters, costs, and utilities were sourced from published literature and real-world data from the screening program.

RESULTS: The screening program reduced HBV-related deaths by 114.24 (1.24% decrease) and lowered the lifetime incidence of HCC by 50.01 cases (0.54% decrease). The program also increased the number of QALYs by 817.93 (0.49% increase), with an additional cost of 39.92 million CNY (17.17% increase). The incremental cost-effectiveness ratio (ICER) was 44,983.68 CNY/QALY, which is below the per capita GDP of China in 2023 (89,358 CNY).

CONCLUSIONS: The implementation of the screening program significantly reduced long-term HBV-related mortality and was cost-effective compared to the status quo in Huazhou City.