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Objectives:Systematic screening for chronic hepatitis B and C does not yet exist in Germany. Therefore, the implementation of a screening approach within a preventive medical examination performed by primary care physicians (‘Check-Up 35+’) was evaluated in a recent prospective multicenter study. The present analysis estimates the financial consequences for the statutory health insurance by budget impact analysis. Materials and methods:A Markov cohort model was developed consisting of 21 health states. Four different screening scenarios derived from the previous multicenter study were compared to usual care, a strategy without screening for hepatitis. Actual cost data for Germany were calculated and systematic literature searches for all input parameters were performed. Results:The base case results in incremental costs for the screening strategies compared to no hepatitis screening of 165–227 € per patient in a 20-year horizon. Two main parameters influence the financial consequences: (A) detection and treatment increase the costs in the beginning. (B) Screening avoids hepatitis induced end-stage liver disease. The initial higher costs exceed the later savings. Sensitivity analyses demonstrate a strong impact of medication costs for the treatment of additionally detected hepatitis infections on the outcome. This finding is robust to sensitivity analysis. Conclusions:The screening strategy proposed here implies additional costs for the statutory health insurance, however, a decision regarding its usefulness must consider criteria other than cost. For example, the high burden of disease due to liver cirrhosis and liver carcinoma should be considered. Therefore, an additional cost-effectiveness-analysis should be conducted. [ABSTRACT FROM PUBLISHER]

ABSTRACT Background Aims Methods Results Conclusions Trial Registration Despite European guidelines recommending anti‐hepatitis D virus (HDV) screening for all hepatitis B surface antigen (HBsAg)‐positive cases, screening rates remain insufficient.We analysed anti‐HDV screening rates in primary care and implemented prospective HDV screening in HBsAg‐positive cases identified in the preventive medical examination from the age of 35 (“Check‐Up 35+”).From 2012 to 2021, we reviewed anti‐HDV and HDV RNA test rates in HBsAg‐positive patients at 11 sites of a large German laboratory group. From 2022 to 2023, we prospectively screened HBsAg‐positive samples from the “Check‐Up 35+” for anti‐HDV. Anti‐HDV positive patients were then contacted again for HDV RNA testing.Retrospectively, 2792/13,905 (20%) HBsAg‐positive cases were tested for anti‐HDV, with 142/2792 (5.1%) being positive. HDV RNA was tested in 57/142 (40%) anti‐HDV‐positive cases, with 26/57 (46%) being positive. In the prospective screening, 1159/225,901 (0.51%) individuals were HBsAg‐positive. Of these, 700 (60%) were tested for anti‐HDV, with 18/700 (2.6%) positive test results. 4/18 (22%) were successfully contacted again for HDV RNA analysis, with one case testing positive. Neither the HBsAg nor the anti‐HDV positive result was known prior to screening in these cases. Anti‐HDV testing could not be performed in 459/1159 (40%) HBsAg‐positive cases, primarily due to insufficient blood sample volume (310/459 cases, 68%), with others missed due to logistical errors.Retrospective data show insufficient anti‐HDV screening in clinical routine. The prospective anti‐HDV screening provides a blueprint for using existing hepatitis B virus screening programms for population‐based HDV double reflex testing, provided that adequate logistical prerequisites are established.German Clinical Trial Register: DRKS00029180 [ABSTRACT FROM AUTHOR]

Since October 2021 in Germany all people with a statutory health insurance aged 35 and older have the right to be tested once for hepatitis B and C in a general preventative examination, regardless of specific risk-factors. This is a milestone on the way of eliminating these infections and also a great contribution to cancer prevention.In the USA the Centers of Disease Control and Prevention in April 2020 recommended a one-time screening for all adults aged 18 and older in addition to testing people with known risk-factors, because a significant part of the affected population cannot be identified with risk-based screening. Corresponding CDC-Recommendations for HBV are currently elaborated. According to available Data this screening strategy combined with a vaccination for HBV is necessary in Germany too to reach the agreed elimination goals till the year of 2030. Furthermore, an offer of such a testing for all adults can be regarded as ethically imperative to prevent as many life-threatening consequences or deaths as possible by effective therapies., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)