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Author Notes:

Corresponding Author: Brian Maskery, 1600 Clifton Road, MS E-03, Atlanta, GA 30333, Email: wqm7@cdc.gov

We acknowledge the comments of Kathy Byrd, MD, MPH, Division of Viral Hepatitis, NCHHSTP, and Dr. Fangjun Zhou, Senior Economist, Immunization Services Division, NCIRD, at the Centers for Disease Control and Prevention.

We also acknowledge the assistance of Blain Mamo of the Minnesota Department of Health and Monica Vargas of the Georgia Department of Public Health. We also acknowledge the input of two reviewers at Vaccine.

The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the Centers for Disease Control and Prevention or the institutions with which the authors are affiliated.



  • Science & Technology
  • Life Sciences & Biomedicine
  • Immunology
  • Medicine, Research & Experimental
  • Research & Experimental Medicine
  • Vaccine
  • Screening
  • Hepatitis B virus
  • Refugee
  • Cost-benefit

Cost-benefit comparison of two proposed overseas programs for reducing chronic Hepatitis B infection among refugees: Is screening essential?


Journal Title:



Volume 33, Number 11


, Pages 1393-1399

Type of Work:

Article | Final Publisher PDF


BACKGROUND: Refugees are at an increased risk of chronic Hepatitis B virus (HBV) infection because many of their countries of origin, as well as host countries, have intermediate-to-high prevalence rates. Refugees arriving to the US are also at risk of serious sequelae from chronic HBV infection because they are not routinely screened for the virus overseas or in domestic post-arrival exams, and may live in the US for years without awareness of their infection status. METHODS: A cohort of 26,548 refugees who arrived in Minnesota and Georgia during 2005-2010 was evaluated to determine the prevalence of chronic HBV infection. This prevalence information was then used in a cost-benefit analysis comparing two variations of a proposed overseas program to prevent or ameliorate the effects of HBV infection, titled 'Screen, then vaccinate or initiate management' (SVIM) and 'Vaccinate only' (VO). The analyses were performed in 2013. All values were converted to US 2012 dollars. RESULTS: The estimated six year period-prevalence of chronic HBV infection was 6.8% in the overall refugee population arriving to Minnesota and Georgia and 7.1% in those ≥6 years of age. The SVIM program variation was more cost beneficial than VO. While the up-front costs of SVIM were higher than VO ($154,084 vs. $73,758; n=58,538 refugees), the SVIM proposal displayed a positive net benefit, ranging from $24 million to $130 million after only 5 years since program initiation, depending on domestic post-arrival screening rates in the VO proposal. CONCLUSIONS: Chronic HBV infection remains an important health problem in refugees resettling to the United States. An overseas screening policy for chronic HBV infection is more cost-beneficial than a 'Vaccination only' policy. The major benefit drivers for the screening policy are earlier medical management of chronic HBV infection and averted lost societal contributions from premature death.

Copyright information:

Published by Elsevier Ltd.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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