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J Viral Hepat. 2019 Dec 19. doi: 10.1111/jvh.13252. [Epub ahead of print]

Enhancing the hepatitis B care cascade in Australia: A cost-effectiveness model.

Xiao Y1,2,3, Howell J1,2,3,4, van Gemert C1,3, Thompson AJ2,3, Seaman CP1,4, McCulloch K3,5,6,7, Scott N1,4, Hellard ME1,3,4,7,8,9.

Author information

Burnet Institute, Melbourne, Vic, Australia.
Department of Gastroenterology, St Vicent's Hospital, Melbourne, Vic, Australia.
University of Melbourne, Melbourne, Vic, Australia.
Monash University, Melbourne, Vic, Australia.
WHO Collaborating Centre for Viral Hepatitis, Melbourne, Vic, Australia.
Victorian Infectious Diseases Reference Laboratory, Melbourne, Vic, Australia.
The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia.
School of Population Health, Monash University, Melbourne, Vic, Australia.
Department of Infectious Diseases, Alfred Hospital, Melbourne, Vic, Australia.


If Australia is to successfully eliminate hepatitis B as a public health threat, it will need to enhance the chronic hepatitis B (CHB) care cascade. This study used a Markov model to assess the impact, cost and cost-effectiveness of scaling up CHB diagnosis, linkage to care and treatment to reach national and international elimination targets for hepatitis B in Australia. Compared to continued current trends, the model calculated the difference in care cascade projection, disability-adjusted life years (DALYs), costs and the incremental cost-effectiveness ratio (ICER), of scaling up CHB diagnosis, linkage to care and treatment to reach: (a) Australia's 2022 national targets and (b) the WHO's 2030 global targets. Achieving the national and WHO targets had ICERs of A$13 435 (A$10 236-A$21 165) and A$14 482 (A$13 031-A$25 641) per DALY averted between 2016 and 2030 in Australia, respectively. However, this excluded implementation and demand generation costs. The ICER for the National Strategy and WHO Strategy remained under A$50 000 per DALY averted if Australia spent up to A$328 or A$538 million, respectively, per annum (for 2016-2030) on implementation and demand generation activities. Sensitivity analysis showed that cost-effectiveness was predominately driven by the cost of CHB treatment and influenced by disease progression rates. Hence for Australia to reach the National Hepatitis B Strategy 2022 targets and WHO Strategy 2030 targets, it requires an improvement in the CHB care cascade. We estimated it is cost-effective to spend up to A$328 million or A$538 million per year to reach the National and WHO Strategy targets, respectively.


care cascade; cost-effectiveness analysis; hepatitis B


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