Universal testing for hepatitis B and hepatitis C in the emergency department: a cost-effectiveness and budget impact analysis of two urban hospitals in the United Kingdom
Abstract Background Numerous studies have shown the effectiveness of testing for hepatitis B (HBV) and hepatitis C (HCV) in emergency departments (ED), due to the elevated prevalence amongst attendees. The aim of this study was to conduct a cost-effectiveness analysis of universal opt-out HBV and HC...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-11-01
|
| Series: | Cost Effectiveness and Resource Allocation |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12962-022-00388-7 |
| _version_ | 1828127872749928448 |
|---|---|
| author | Jack Williams Peter Vickerman Elizabeth Smout Emma E. Page Khine Phyu Mark Aldersley Gaia Nebbia Sam Douthwaite Laura Hunter Murad Ruf Alec Miners |
| author_facet | Jack Williams Peter Vickerman Elizabeth Smout Emma E. Page Khine Phyu Mark Aldersley Gaia Nebbia Sam Douthwaite Laura Hunter Murad Ruf Alec Miners |
| author_sort | Jack Williams |
| collection | DOAJ |
| description | Abstract Background Numerous studies have shown the effectiveness of testing for hepatitis B (HBV) and hepatitis C (HCV) in emergency departments (ED), due to the elevated prevalence amongst attendees. The aim of this study was to conduct a cost-effectiveness analysis of universal opt-out HBV and HCV testing in EDs based on 2 long-term studies of the real-world effectiveness of testing in 2 large ED’s in the UK. Methods A Markov model was used to evaluate ED-based HBV and HCV testing versus no ED testing, in addition to current testing practice. The two EDs had a HBV HBsAg prevalence of 0.5–0.9% and an HCV RNA prevalence of 0.9–1.0%. The analysis was performed from a UK health service perspective, over a lifetime time horizon. Costs are reported in British pounds (GBP), and outcomes as quality adjusted life years (QALYs), with both discounted at 3.5% per year. Incremental cost-effectiveness ratios (ICER) are calculated as costs per QALY gained. A willingness-to-pay threshold of £20,000/QALY was used. The cost-effectiveness was estimated for both infections, in both ED’s. Results HBV and HCV testing were highly cost-effective in both settings, with ICERs ranging from £7,177 to £12,387 per QALY gained. In probabilistic analyses, HBV testing was 89–94% likely to be cost-effective at the threshold, while HCV testing was 94–100% likely to be cost-effective, across both settings. In deterministic sensitivity analyses, testing remained cost-effective in both locations at ≥ 0.25% HBsAg prevalence, and ≥ 0.49% HCV RNA prevalence. This is much lower than the prevalence observed in the two EDs included in this study. Conclusions HBV and HCV testing in urban EDs is highly cost-effective in the UK, and can be cost-effective at relatively low prevalence. These results should be reflected in UK and European hepatitis testing guidelines. |
| first_indexed | 2024-04-11T15:57:20Z |
| format | Article |
| id | doaj.art-dbc8136f51b746049c458b84ea136a50 |
| institution | Directory Open Access Journal |
| issn | 1478-7547 |
| language | English |
| last_indexed | 2024-04-11T15:57:20Z |
| publishDate | 2022-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Cost Effectiveness and Resource Allocation |
| spelling | doaj.art-dbc8136f51b746049c458b84ea136a502022-12-22T04:15:08ZengBMCCost Effectiveness and Resource Allocation1478-75472022-11-0120111210.1186/s12962-022-00388-7Universal testing for hepatitis B and hepatitis C in the emergency department: a cost-effectiveness and budget impact analysis of two urban hospitals in the United KingdomJack Williams0Peter Vickerman1Elizabeth Smout2Emma E. Page3Khine Phyu4Mark Aldersley5Gaia Nebbia6Sam Douthwaite7Laura Hunter8Murad Ruf9Alec Miners10Department of Health Services Research and Policy, London School of Hygiene and Tropical MedicineBristol Medical School, Population Health Sciences, University of BristolUK Field Epidemiology Training Programme, UK Health Security AgencyVirology, Microbiology Department, Leeds Teaching Hospitals TrustVirology, Microbiology Department, Leeds Teaching Hospitals TrustVirology, Microbiology Department, Leeds Teaching Hospitals TrustDepartment of Infection, Guy’s and St Thomas’ NHS Foundation TrustDepartment of Infection, Guy’s and St Thomas’ NHS Foundation TrustEmergency Department, Guy’s and St Thomas’ NHS Foundation TrustPublic Health-Medical Department, Gilead Sciences Ltd UK and IrelandDepartment of Health Services Research and Policy, London School of Hygiene and Tropical MedicineAbstract Background Numerous studies have shown the effectiveness of testing for hepatitis B (HBV) and hepatitis C (HCV) in emergency departments (ED), due to the elevated prevalence amongst attendees. The aim of this study was to conduct a cost-effectiveness analysis of universal opt-out HBV and HCV testing in EDs based on 2 long-term studies of the real-world effectiveness of testing in 2 large ED’s in the UK. Methods A Markov model was used to evaluate ED-based HBV and HCV testing versus no ED testing, in addition to current testing practice. The two EDs had a HBV HBsAg prevalence of 0.5–0.9% and an HCV RNA prevalence of 0.9–1.0%. The analysis was performed from a UK health service perspective, over a lifetime time horizon. Costs are reported in British pounds (GBP), and outcomes as quality adjusted life years (QALYs), with both discounted at 3.5% per year. Incremental cost-effectiveness ratios (ICER) are calculated as costs per QALY gained. A willingness-to-pay threshold of £20,000/QALY was used. The cost-effectiveness was estimated for both infections, in both ED’s. Results HBV and HCV testing were highly cost-effective in both settings, with ICERs ranging from £7,177 to £12,387 per QALY gained. In probabilistic analyses, HBV testing was 89–94% likely to be cost-effective at the threshold, while HCV testing was 94–100% likely to be cost-effective, across both settings. In deterministic sensitivity analyses, testing remained cost-effective in both locations at ≥ 0.25% HBsAg prevalence, and ≥ 0.49% HCV RNA prevalence. This is much lower than the prevalence observed in the two EDs included in this study. Conclusions HBV and HCV testing in urban EDs is highly cost-effective in the UK, and can be cost-effective at relatively low prevalence. These results should be reflected in UK and European hepatitis testing guidelines.https://doi.org/10.1186/s12962-022-00388-7Hepatitis BHepatitis CEmergency departmentEconomic evaluationBudget impact |
| spellingShingle | Jack Williams Peter Vickerman Elizabeth Smout Emma E. Page Khine Phyu Mark Aldersley Gaia Nebbia Sam Douthwaite Laura Hunter Murad Ruf Alec Miners Universal testing for hepatitis B and hepatitis C in the emergency department: a cost-effectiveness and budget impact analysis of two urban hospitals in the United Kingdom Cost Effectiveness and Resource Allocation Hepatitis B Hepatitis C Emergency department Economic evaluation Budget impact |
| title | Universal testing for hepatitis B and hepatitis C in the emergency department: a cost-effectiveness and budget impact analysis of two urban hospitals in the United Kingdom |
| title_full | Universal testing for hepatitis B and hepatitis C in the emergency department: a cost-effectiveness and budget impact analysis of two urban hospitals in the United Kingdom |
| title_fullStr | Universal testing for hepatitis B and hepatitis C in the emergency department: a cost-effectiveness and budget impact analysis of two urban hospitals in the United Kingdom |
| title_full_unstemmed | Universal testing for hepatitis B and hepatitis C in the emergency department: a cost-effectiveness and budget impact analysis of two urban hospitals in the United Kingdom |
| title_short | Universal testing for hepatitis B and hepatitis C in the emergency department: a cost-effectiveness and budget impact analysis of two urban hospitals in the United Kingdom |
| title_sort | universal testing for hepatitis b and hepatitis c in the emergency department a cost effectiveness and budget impact analysis of two urban hospitals in the united kingdom |
| topic | Hepatitis B Hepatitis C Emergency department Economic evaluation Budget impact |
| url | https://doi.org/10.1186/s12962-022-00388-7 |
| work_keys_str_mv | AT jackwilliams universaltestingforhepatitisbandhepatitiscintheemergencydepartmentacosteffectivenessandbudgetimpactanalysisoftwourbanhospitalsintheunitedkingdom AT petervickerman universaltestingforhepatitisbandhepatitiscintheemergencydepartmentacosteffectivenessandbudgetimpactanalysisoftwourbanhospitalsintheunitedkingdom AT elizabethsmout universaltestingforhepatitisbandhepatitiscintheemergencydepartmentacosteffectivenessandbudgetimpactanalysisoftwourbanhospitalsintheunitedkingdom AT emmaepage universaltestingforhepatitisbandhepatitiscintheemergencydepartmentacosteffectivenessandbudgetimpactanalysisoftwourbanhospitalsintheunitedkingdom AT khinephyu universaltestingforhepatitisbandhepatitiscintheemergencydepartmentacosteffectivenessandbudgetimpactanalysisoftwourbanhospitalsintheunitedkingdom AT markaldersley universaltestingforhepatitisbandhepatitiscintheemergencydepartmentacosteffectivenessandbudgetimpactanalysisoftwourbanhospitalsintheunitedkingdom AT gaianebbia universaltestingforhepatitisbandhepatitiscintheemergencydepartmentacosteffectivenessandbudgetimpactanalysisoftwourbanhospitalsintheunitedkingdom AT samdouthwaite universaltestingforhepatitisbandhepatitiscintheemergencydepartmentacosteffectivenessandbudgetimpactanalysisoftwourbanhospitalsintheunitedkingdom AT laurahunter universaltestingforhepatitisbandhepatitiscintheemergencydepartmentacosteffectivenessandbudgetimpactanalysisoftwourbanhospitalsintheunitedkingdom AT muradruf universaltestingforhepatitisbandhepatitiscintheemergencydepartmentacosteffectivenessandbudgetimpactanalysisoftwourbanhospitalsintheunitedkingdom AT alecminers universaltestingforhepatitisbandhepatitiscintheemergencydepartmentacosteffectivenessandbudgetimpactanalysisoftwourbanhospitalsintheunitedkingdom |