Table 2 Summary of included studies, with further details in Additional file 3. ‘Infection’ refers to chronic hepatitis B infection

 Chen et al., 2016 [32]

China, pregnant women

Decision tree (for outcome post-intervention), linked with Markov model (for health outcomes, if infected with HBC).

(1) no screening, no vaccination or

(2) no screening, universal three-dose hepatisis B vaccination (HBV) vaccination for newborns

both compared to

(3) screening, universal three-dose HBV vaccination + hepatitis B immunoglobulin (HBIG) for newborns of hepatitis B antigen surface antigen (HBsAg)-positive.

(3) versus (1): 12.49 million infections and 0.58 million early deaths averted. Direct and societal costs of averted illness was $12.25 billion and $47.35 billion, respectively. Benefit to cost ratios (BCRs) from direct and social perspective of 61.3 and 193.2, respectively. Sensitivity analyses indicated BCRs remaining above 1.0 regardless of changes in parameter values.

(3) versus (2): there were 3500 infections averted. BCRs from direct and social perspective of 0.4 and 2.7, respectively. No costs averted were reported.

 Vimolket and Poovorawan, 2005 [36]

Thailand, pregnant women

Decision tree modelling

(1) Universal vaccination of newborns, HBIG if mother HBsAg-positive versus

(2) universal vaccination of newborns, HBeAg if HBsAg-positive, HBIG if positive for both versus

(3) universal vaccination of newborns, no screening, no HBIG (current strategy) versus

(4) no vaccination of newborns, no screening of pregnant women.

(1) Cost = $944, expected cases prevented = 99.9, cost-effectiveness (CE) = $9.5 baht/case prevented, Incremental cost-effectiveness ratio (ICER) = $3067 /case prevented, relative to strategy 2). Total annual cost (for 800,000 cohort) = $7.55 million.

(2) Cost = $852, expected cases prevented = 99.87, CE = $8.5/case prevented, ICER = $646 per case prevented, relative to strategy 3). Total annual cost = $6.82 million.

(3) Cost = $484, expected cases prevented = 99.30, CE = $4.9/case prevented, ICER = $211/case prevented, relative to strategy 4). Total annual cost = $3.87 million

(4) Cost = $0, expected cases prevented = 97, CE = 0, ICER N/A.

Through strategy 4 cases are still ‘prevented’ (newborns are born without HBV infection) because model assumes only 3% of newborns will become a carrier via vertical transmission for this population.

 Aggarwal and Naik, 1994 [31]

India, pregnant women

Decision tree modelling

(1) Universal vaccination, no screening versus

(2) HBsAg screening, vaccination for newborns only if mother positive.

(1) 341.2 carriers/10,000 newborns born prevented, total cost $71,169, therefore $209/carrier prevented.

(2) 44.8 carriers/10,000 newborns born prevented, total cost $36, 713, therefore $819/carrier prevented

 Guidozzi et al., 1993 [33]

South Africa, pregnant women

Prevalence study in relation to a ‘hypothetical worst-case scenario’

(1) Screening and HBV vaccination of newborns if mother HBsAg-positive versus

(2) no screening, no vaccination.

Estimation of 7 HBV infections averted (1/500 births; 3469 women screened), total cost of $44,029, costs per case averted (compared to no screening) of $6290 with cost of each HBsAg screening test estimated as $12.7.

 Lansang et al., 1989 [34]

Philippines, pregnant women

Decision tree modelling

Three screening strategies ( (1–3) rapid ‘finger prick’ test, venous sampling with two different assays) with:

a) selective HBV vaccination of newborns +/−

b) HBIG and (4) universal vaccination.

Cost-effectiveness defined as expected cost (EC in pesos)/expected ‘utility’^b (EU) per person)

(1) a) HBV vaccine alone: EC = $1.2, EU = 0.9, EC/EU = $1.3

b) HBV vaccine & HBIG: EC = $3.3, EU = 0.9, EC/EU = $3.6

(2) a) HBV vaccine alone: EC = $1.2, EU = 0.89, EC/EU = $1.4

b) HBV vaccine & HBIG: EC = $2.3, EU = 0.89, EC/EU = $2.6

(3) a) HBV vaccine alone: EC = $9.2, EU = 0.90, EC/EU = $10.2

b) HBV vaccine & HBIG: EC = $9.8, EU = 0.9, EC/EU = $11

(4) EC = $14.8, EU = 0.95, EC/EU = $15.6

 Nayagam. et al., 2016 [35]

The Gambia, adults 38 years old or older

Decision tree combined with Markov models

Comparing screening and treatment

versus current practice of no publicly provided screening or treatment.

498 additional disability-adjusted life years (DALYs) averted, 417 life year (LY) gained, or 526 quality-adjusted life years (QALYs) saved (all per round). Incremental cost-effectiveness ratios (ICERs) of $566/ DALY averted, $677 /LY saved, $536 / QALY gained

 Zheng et al., 2015 [38]

China, adults

Decision tree modelling

Adults separately analysed as 21–39 year olds, 40–59 year olds, and 21–59 year olds together comparing:

(1) Vaccination of adults with no screening or

(2) vaccination of adults following screening for HBV core antigen

both compared to

(3) no vaccination, no screening of adults.

Young adults (21–39 years):

(1) versus (3): direct costs of $1.54 billion and costs averted $1.64 billion; societal costs of $2.16 billion and costs averted of $3.08 billion, yielding BCRs of 1.06 and 1.42 respectively

(2) versus (3): direct costs of $1.64 billion and costs averted $1.95 billion; societal costs of $2.16 billion and costs averted of $3.70 billion, yielding a BCRs of 1.19 and 1.73 respectively.

Middle-aged adults (40–59 years):

(1) versus (3): direct costs of $1.44 billion and costs averted of $0.82 billion; societal costs of $2.06 billion and costs averted of $1.23 billion, yielding BCRs of 0.59 for both perspectives;

(2) versus (3): direct costs of $1.54 billion and costs averted of $1.03 billion; societal costs of $2.06 billion and costs averted of $1.54 billion, yielding BCRs of 0.68 and 0.73 respectively.

 Wiwanitkit, 2009 [37]

Thailand, people travelling abroad for work

Extrapolation of cross-sectional study data to 10,000 person cohort

(1) Screening before travelling abroad versus

(2) returning home if found to be infected with HBV after travelling abroad for work.

(1) Cost of screening 10,000 workers = $75, 711

(2) Cost of returning home from within Asia (if no workers screened prior to leaving) = $157,479. Cost from returning home from outside of Asia (if no workers screened prior to leaving) = $472,437.

Therefore, cost saving from screening 10,000 workers prior to leaving = $81,768 – $396,726

 Adibi et al., 2004 [30]

Iran, pre-marriage couples

Decision tree modelling

(1) Screening for HBsAg and giving protection protocol (HBV vaccine, condoms to seronegative partner, if other individual is seropositive or

(2) as above with further screening for HBV core antibody and protection protocol if negative for both (and partner positive) both compared to

(3) no screening or prevention.

(1) versus (3): $ 269/infection averted

(2) versus (3): $ 263/infection averted

Threshold analysis (discounted at 3%, cost of CLD above which screening strategies are cost saving):

(1) versus (3): $3758

(2) versus (3): $ 3663