Hepatitis B in migrants: burden of infection and the cost-effectiveness of interventions to decrease associated morbidity and mortality
Bibliographic record
Abstract
Background: Immigrants and refugees have increased morbidity and mortality from liver disease compared to host populations largely due to undetected chronic hepatitis B virus (HBV) infection. We conducted a systematic review of the seroprevalence of chronic HBV and prior immunity in migrants arriving in immigrant-receiving countries to identify the proportion who would benefit from HBV screening and vaccination programs. We then performed a cost-effectiveness analysis to identify the optimal intervention for adult immigrants and refugees arriving in Canada. Methods: Four electronic databases were searched to identify studies that reported HBV surface antigen (HBsAg) and HBV surface antibodies (anti-HBs) in international migrants. Proportions for chronic HBV and prior immunity were transformed using the logit transformation and pooled using a random-effects model. A decision-analysis model was then developed to examine the cost-effectiveness of four screening and vaccination strategies, compared to no screening or vaccination: a) universal vaccination, b) anti-HBs screening and vaccination of susceptibles, c) HBsAg screening and antiviral treatment, d) combined HBsAg and anti-HBs screening. Model parameters for the seroprevalence of infection and immunity were obtained from the systematic review. Estimates for disease progression, medical costs and utilities were obtained from the published literature.Results: The overall pooled seroprevalence of infection in international migrants was 7.2% (95% CI: 6.3% – 8.2%) and the proportion with prior immunity was 39.7% (95% CI: 35.7% – 43.9%). HBV seroprevalence differed significantly by region of origin with migrants from East Asia and Sub-Saharan Africa at highest risk of infection and migrants from Eastern Europe at intermediate risk. None of the strategies were found to be cost-saving, but screening for HBsAg to identify chronically infected immigrants was found to be the most cost-effective strategy and would cost $37,675 per quality-adjusted life year (QALY) gained, compared to no intervention. Results were sensitive to the cost and effectiveness of antiviral therapy. A probabilistic sensitivity analysis demonstrated that the screen and treat strategy would have an 84% chance of having an incremental cost-effectiveness ratio of < $50,000 per QALY gained.Conclusions: The seroprevalence of chronic HBV is high in migrants from most world regions, particularly among those from East Asia, Sub-Saharan Africa and Eastern Europe. Screening adult immigrants soon after arrival would be cost-effective and would reduce morbidity and mortality from HBV.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.042 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.005 | 0.009 |
| Bibliometrics | 0.004 | 0.004 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".