Cost-Effectiveness of One-time Universal Testing for Hepatitis D Among Adults With Chronic Hepatitis B in the United States

Background. Chronic hepatitis D virus (HDV) infection increases the risk of liver-related deaths in adults with chronic hepatitis B (CHB). In the United States (US), only an estimated 12.9% of adults with CHB have received an HDV antibody test. The aim of this study is to calculate the cost-effectiveness of one-time universal HDV testing of hepatitis B surface antigen (HBsAg)–positive adults living in the US. Methods. A Markov model was used to calculate the costs, health impact, and cost-effectiveness of universal testing of HBsAg-positive adults with an HDV antibody test and, when positive, an HDV RNA test for chronic HDV infection. We assumed that 50% of the HDV RNA–positive patients would receive the current recommended treatment with pegylated interferon (PEG-IFN) for 48 weeks with a 30% response rate. We also modeled the potential impact of hypothetical indefinite HDV antiviral therapy with a higher response rate to assess the annual cost threshold to be considered cost-effective. Results. Universal HDV testing of adults with CHB could avert 100 HDV-related deaths and an additional 30 cases of cirrhosis and 50 cases of hepatocellular carcinoma, and potentially result in a gain of 1500 quality-adjusted life-years (QALYs) per 100 000 HBsAg-positive individuals screened. At a willingness-to-pay threshold of $50 000 per QALY, the annual drug costs for a hypothetical indefinite therapy with a 50% or 70% treatment response rate would need to cost ≤$13 027 and ≤$14 104, respectively. Conclusions. One-time HDV testing for all HBsAg-positive adults and treatment of chronic HDV infection with PEG-IFN is potentially cost-effective in the US.