Objective To analyze the cost-effectiveness of various screening strategies for hepatitis B virus (HBV) infection in the Chinese population and to provide evidence for developing the most cost-effective strategy for HBV prevention and control in China.

Methods Data on HBV infection-related costs, transition probabilities, and health utility values were obtained using literature analysis, polynomial regression model simulation, and reports or monographs from authoritative health institutions. We constructed a multi-stage decision tree model for 11 different target populations across various age groups ranging from 0 to 70 years in China under five serological testing strategies: hepatitis B surface antigen (HBsAg) rapid test (one-item screening), HBsAg/hepatitis B surface antibody (HBsAb) test (two-item screening), HBsAg/HBsAb/hepatitis B core antibody (HBcAb) test (three-item screening), HBsAg/HBsAb/hepatitis B e antigen (HBeAg)/hepatitis B e antibody (HBeAb)/HBcAb test (five-item screening), and no screening, with 10 μg doses of hepatitis B vaccine administered at 0, 1, and 6 months. A Markov model was used to simulate the health outcomes of susceptible individuals after HBV infection. We calculated the costs and effects of different screening strategies, compared the incremental cost-effectiveness ratios (ICERs) of different screening programs, and used univariate and probabilistic sensitivity analyses to assess the robustness of the results, using the 0–20 years age group as an example.

Results Baseline analysis showed that the three-item HBV screening strategy was the most cost-effective in the 0–20 years age group, with an investment of 3 188.19 yuan (RMB) yielding 26.74 quality-adjusted life years (QALYs). Compared with the three-item screening strategy, the five-item screening, two-item screening, one-item screening, and no screening strategies required additional investments of 27 178.37 yuan, 25 723.66 yuan, 25 723.07 yuan, and 25 696.48 yuan, respectively, per QALY lost, making them absolutely inferior strategies. In age groups other than 0–20 years, the five-item HBV screening strategy was the most cost-effective. The cost-effectiveness ranking, from highest to lowest, was as follows: 30–70 years, 0–30 years, 30–60 years, 20–70 years, 30–50 years, 20–60 years, 30–40 years, 20–50 years, 20–40 years, and 20–30 years. Compared with the three-item screening strategy in the 0–20 years age group, the five-item screening strategy in other age groups required additional investments of 352.20 yuan, 472.60 yuan, 492.98 yuan, 550.42 yuan, 757.71 yuan, 835.50 yuan, 1 018.78 yuan, 1 173.34 yuan, 1 910.08 yuan, and 2 612.61 yuan, respectively, per QALY lost, also making them absolutely inferior strategies. Using the 0–20 years age group as an example, univariate sensitivity analysis revealed that the vaccination rate had the greatest impact on net monetary benefit (NMB). Probabilistic sensitivity analysis demonstrated that the dominant strategy in this study had a greater cost-effectiveness advantage compared to other strategies. The sensitivity analysis results were consistent with those of the baseline analysis.

Conclusions The three-item HBV screening strategy (including HBsAg, anti-HBc, and anti-HBs) was found to be the most cost-effective approach for preventing and controlling HBV infection in the Chinese population aged 0–20 years, compared to other screening strategies.