Economic evaluations of the primary prevention programs for viral hepatitis-related liver disease and liver cancer: a systematic literature review

Abstract

Background: Viral hepatitis, including hepatitis B virus (HBV) and hepatitis C virus (HCV), significantly contributes to the global burden of liver disease and hepatocellular carcinoma. This systematic review evaluates the cost-effectiveness of primary prevention strategies for viral hepatitis-related liver disease and liver cancer in high-income countries. Main text: We systematically searched electronic databases (January 2013 to June 2024) for economic evaluations of HBV/HCV prevention strategies. Quality assessment used Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guidelines. Analysis included model structures, assumptions, outcome measures, and cost-effectiveness findings. Twenty-one economic evaluations were included (13 USA, 8 Europe/ Canada). Most used Markov models with time horizons ranging from five years to lifetime. Universal screening was cost-effective across different populations, with Incremental Cost-Effectiveness Ratios (ICERs) ranging from $11,378-$28,000 per Quality-Adjusted Life Years (QALY) for universal HCV screening. Early HCV treatment (F0-F2) was cost-effective compared to delayed treatment. Universal HBV vaccination showed substantial economic benefits. Most interventions were cost-effective according to country-specific willingness-to-pay thresholds, though treatment costs remained a significant barrier to implementation. Conclusions: Primary prevention strategies for viral hepatitis-related liver disease are generally cost-effective, particularly in high-risk populations. Universal screening and early treatment were associated with improved health outcomes, including reductions in hepatocellular carcinoma, cirrhosis, and liver-related mortality. However, significant variations in methodological approaches limit direct comparability across studies and across countries.