A cost-effectiveness analysis of in-hospital screening and diagnosing procedures for hepatitis E virus infection

Abstract

Abstract: Objective To compare the cost-effectiveness of various screening and diagnosing procedures for hepatitis E virus (HEV) infection, and optimize the HEV screening scheme in medical institutions. Methods Seven departments in Shanghai Ruijin Hospital were selected, where patients at high risk of HEV infection or bearing extrahepatic manifestations after HEV infection are relatively concentrated. Patients from these departments who tested HEV antibody from January 2024 to October 2024 were prospectively included. The accuracy rate and cost-effectiveness of various HEV screening and diagnostic strategies were compared. Results Among 2,420 enrolled subjects, 949 (39.2%), 161 (6.7%) and 115 (4.8%) patients were positive for anti-HEV IgG, anti-HEV IgM and HEV RNA, respectively. There were statistically significant differences of anti-HEV IgG positive rate (25.6%~50.0%), IgM positive rates (0.0%~19.7%) and HEV RNA positive rates (0.0%~16.5%) among departments (χ²=86.9, 272.9 and 292.1, respectively, all P<0.000 1). The vast majority of patients with positive HEV RNA had abnormal alanine aminotransferase (ALT) levels (≥2×ULN) at the time of admission (111/115, 96.5%), with a median ALT level of 825 U/L (interquartile range 365~1 599 U/L). The HEV RNA positive rate was significantly higher in the patients with abnormal ALT (111/501, 22.2%) than those patients with normal ALT (4/1 919, 0.2%) (χ²=422.8, P<0.000 1). Compared with simultaneously detecting anti-HEV IgG and IgM, the cost of detecting anti-HEV IgM alone was halved (2 664.2 CNY vs. 1 308.1 CNY for diagnostic cost per case with HEV infection), and the accuracy rate was comparable (97.9% vs. 97.8%). Screening for HEV antibodies or nucleic acid markers in the ALT-abnormal population saved 80% of the cost compared with screening in the general population, while the specificity and accuracy were basically unchanged. Conclusion The detection of anti-HEV IgG has limited contribution in improving the screening efficiency of HEV infection. Conducting HEV screening only in patients with abnormal ALT levels can significantly reduce medical expenses.

Key words: Hepatitis E virus, In-hospital screening, Diagnosis, Cost-effectiveness

Li Wenjing, Li Ziqiang, Li Qing, Xie Qing, Lu Jie. A cost-effectiveness analysis of in-hospital screening and diagnosing procedures for hepatitis E virus infection[J]. Chinese Hepatolgy, 2026, 31(6): 798-803.

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