Screening all adults for hepatitis B likely to improve health outcomes and save costs

Earlier this month, the Centers for Disease Control and Prevention recommended that all U.S. adults 18 and older be screened at least once for chronic hepatitis B virus infection. In addition to improving health outcomes for individuals, the screening is likely to be cost-effective, according to a 2021 analysis published in Clinical Infectious Diseases and cited in support of the new recommendation.

Two thirds of the estimated 1.6 million to 2.4 million people in the U.S. who are infected with HBV are thought to be unaware of it. For every 100,000 adults tested, universal screening would likely prevent an additional 7.4 cases of compensated cirrhosis, 3.3 cases of decompensated cirrhosis, 5.5 cases of hepatocellular carcinoma, 1.9 liver transplants and 10.3 HBV-related deaths, compared with current practice, the CID analysis found. Such screening would also save about $263,000 for every 100,000 adults tested.

The new recommendation for universal screening was outlined in a March 10 MMWR article that updated CDC’s previous guidance for HBV screening for adults published in 2008.

“Chronic HBV infection can lead to substantial morbidity and mortality but is detectable before the development of severe liver disease using reliable and inexpensive screening tests,” the MMWR article’s authors wrote in their rationale for expanded testing. “Although there is no current treatment that can cure HBV, “early diagnosis and treatment of chronic HBV infections reduces the risk for cirrhosis, liver cancer and death,” they noted. The new screening guidance also complements the 2022 recommendation from CDC’s Advisory Committee on Immunization Practices that all adults 18 to 59 years old be vaccinated against HBV.   

The current HBV screening recommendation for adults is based on multiple risk categories and can be difficult to implement in primary care settings. This guidance also has not led to significant increases in HBV testing, diagnosis and treatment, despite this screening being covered by the Affordable Care Act and by the Centers for Medicare and Medicaid Services as a routine preventive service, the CID authors noted.

A related viewpoint published in JAMA, also on March 10, highlighted that while anyone in the U.S. can be infected with HBV, the outcomes of the infection disproportionately affect Asian and Black people, according to CDC surveillance data: Asian people are nine times more likely — and Black people are 2.5 times more likely — to die from hepatitis B–related complications than non-Hispanic White people in the U.S.

HBV testing has been recommended for all pregnant people since 1988, along with vaccination for all infants since 1991, and chronic HBV infection is currently uncommon in children in the U.S, the 2021 CID analysis noted, suggesting the impact universal screening and vaccination recommendations can have.