Evaluating the cost-effectiveness and clinical impact of expanding treatment criteria for chronic hepatitis B

Objective New guidelines from the WHO (2024) and the European Association for the Study of the Liver (EASL, 2025) aim to expand treatment eligibility for those living with chronic hepatitis B (CHB) in order to reduce the risk of liver-related complications and hepatocellular carcinoma (HCC). The aim of this study is to assess the cost-effectiveness and health impact of expanding treatment criteria for CHB according to updated international guidelines in a UK setting. Method Expanded treatment criteria for treating CHB from the EASL 2017, WHO 2024 and EASL 2025 guidelines were applied in a 10-year Markov state transition model to a population of patients with CHB under secondary care at a large service in the UK. Key outcomes were change in cost, quality-adjusted life years (QALYs), mortality, progression to cirrhosis and development of HCC. Results All three expanded treatment scenarios provided improved clinical outcomes at a lower cost compared with the status quo of using the EASL 2017 ‘should’ criteria. The most comprehensive WHO 2024 guideline provided a mean cost saving of £10 233.55 over a 10-year period compared with the status quo, a gain of 87.25 QALYs, 12 fewer deaths, 12 fewer patients progressing to cirrhosis and three fewer cases of HCC. Conclusion The findings strongly suggest that implementing the most up-to-date international guidelines on CHB treatment in a UK setting will not only reduce healthcare costs, but will save lives and reduce morbidity. UK centres caring for patients living with CHB must not hesitate to examine their own practice and ensure it is up to date.