Clinical Infectious Diseases
Volume 52 Issue 11 June 1, 2011
http://www.journals.uchicago.edu/toc/cid/current

Vincent Lo Re III
Editorial Commentary: Economic Analysis of Hepatitis B Screening and Treatment
Clin Infect Dis. (2011) 52(11): 1307-1309 doi:10.1093/cid/cir238

Extract
Approximately 350 million people worldwide are living with chronic hepatitis B virus (HBV) infection, and an estimated 620,000 die annually from complications of HBV-related liver disease [ 1]. In the United States, the incidence of acute HBV infection has declined substantially since 1985 as a result of the availability of effective HBV vaccines and widespread immunization of infants and high-risk populations [ 2]. Nevertheless, approximately 43,000 new cases of acute HBV infection occur each year in the United States [ 3]. Further, although vaccination programs have successfully reduced the incidence, the prevalence of chronic HBV infection has not declined, primarily because of the immigration of chronically infected persons from countries with high or intermediate HBV endemicity [ 4]. National surveys indicate that approximately 1.25 million US residents have chronic HBV infection (prevalence, 0.3%–0.5%) [ 5], and many are likely unaware of their infection status [ 6].

The public health impact of chronic HBV infection is almost entirely related to its long-term effects on liver-related complications [ 7, 8]. Specifically, chronic HBV infection is a major cause of cirrhosis, hepatic decompensation, and hepatocellular carcinoma, and the risk of these complications increases with higher HBV DNA levels [ 9, 10]. The number of hospitalizations, outpatient visits, and expenditures associated with chronic HBV infection has persistently increased over the past 20 years [ 4, 11], and as the influx of patients with chronic HBV infection in the United States continues, utilization of HBV-related health care …