Impact of hepatitis D reflex testing on the future disease burden: A modelling analysis

Abstract

AbstractChronic hepatitis D (CHD) is a severe form of viral hepatitis that leads to liver cirrhosis and hepatocellular carcinoma. CHD is underdiagnosed, and this study aimed to assess the impact of hepatitis D reflex testing in HBsAg‐positive individuals in Spain over the next 8 years. Two scenarios were compared: the current situation (7.6% of HBsAg‐positive patients tested for anti‐HDV) and reflex testing for all positive samples. A decision tree model was designed to simulate the CHD care cascade. Implementing reflex testing would increase anti‐HDV detection to 5498 cases and HDV‐RNA to 3225 cases. Additionally, 2128 more patients would receive treatment, with 213 achieving undetectable HDV‐RNA levels. The cost per anti‐HDV case detected would be €132. In the median time of the analysis, liver complications (decompensated cirrhosis, HCC and liver‐related deaths) would be reduced by 35%–38%, implying an estimated cost savings of 36 million euros associated with the management of such complications. By 2030, implementing anti‐HDV reflex testing would reduce the clinical and economic burden of CHD by 35%–38%.