摘要：SummaryBackground Despite the high burden of hepatitis B virus (HBV) infection in sub-Saharan Africa, absence of widespread screening and poor access to treatment leads to most people remaining undiagnosed until later stages of disease when prognosis is poor and treatment options are limited. We examined the cost-effectiveness of community-based screening and early treatment with antiviral therapy for {HBV} in The Gambia. Methods In this economic evaluation, we combined a decision tree with a Markov state transition model to compare a screen and treat intervention consisting of adult community-based screening using a hepatitis B surface antigen (HBsAg) rapid test and subsequent {HBV} antiviral therapy versus current practice, in which there is an absence of publicly provided screening or treatment for HBV. We used data from the {PROLIFICA} study to parameterise epidemiological, primary screening, and cost information, and other model parameter inputs were obtained from a literature search. Outcome measures were cost per disability-adjusted life-year (DALY) averted; cost per life-year saved; and cost per quality-adjusted life-year (QALY) gained. We calculated the incremental cost-effectiveness ratios (ICERs) between current practice and the screen and treat intervention. Costs were assessed from a health provider perspective. Costs (expressed in 2013 US$) and health outcomes were discounted at 3% per year. Findings In The Gambia, where the prevalence of {HBsAg} is 8·8% in people older than 30 years, adult screening and treatment for {HBV} has an incremental cost-effectiveness ratio (ICER) of $540 per {DALY} averted, $645 per life-year saved, and $511 per {QALY} gained, compared with current practice. These {ICERs} are in line with willingness-to-pay levels of one times the country's gross domestic product per capita ($487) per {DALY} averted, and remain robust over a wide range of epidemiological and cost parameter inputs. Interpretation Adult community-based screening and treatment for {HBV} in The Gambia is likely to be a cost-effective intervention. Higher cost-effectiveness might be achievable with targeted facility-based screening, price reductions of drugs and diagnostics, and integration of {HBV} screening with other public health interventions. Funding European Commission.
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