The cost-effectiveness of increasing hepatitis Delta testing for individuals co-infected with HBV and HIV in the Netherlands

OBJECTIVES: Chronic hepatitis D virus (HDV) infection accelerates liver-related morbidity and mortality in people living with HIV and hepatitis B virus (HBV). In the Netherlands, HDV testing among HIV/HBV-coinfected adults is currently limited. This study evaluates whether a one-time HDV testing strategy for all HIV/HBsAg-positive adults is cost-effective compared with the current limited testing strategy. METHODS: A Markov model was developed and followed HIV/HBV-coinfected adults through mutually exclusive health states. One-time testing scenario comprised of anti-HDV testing with HDV RNA confirmation, and bulevirtide in combination of interferon therapy for 50% of viremic patients. Clinical and cost inputs were sourced from clinical studies and the Dutch costing manual. Utilities used EQ-5D values for HBV/HDV patients assuming controlled HIV infection. Sensitivity analyses explored parameter uncertainty. RESULTS: One-time HDV testing could avert 174 HDV-related deaths, 95 cirrhosis cases, and 111 liver cancer cases per 10,000 individuals with HIV/HBV infection. The intervention yields 0.253 additional quality-adjusted life-years (QALYs) at an incremental cost of €5,026, resulting in an ICER of €19,881/QALY, which is below the Dutch willingness-to-pay threshold of €80,000/QALY. CONCLUSION: One-time HDV testing among HIV/HBV-coinfected adults in the Netherlands appears cost-effective and clinically impactful, supporting routine HDV testing into national HIV/HBV care protocols.