{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T05:03:12Z","timestamp":1785301392261,"version":"3.55.0"},"reference-count":47,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,7,19]],"date-time":"2026-07-19T00:00:00Z","timestamp":1784419200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,7,19]],"date-time":"2026-07-19T00:00:00Z","timestamp":1784419200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Viral Hepatitis"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Hepatitis D is common among immigrants in Canada, who account for approximately 23% of the population and tend to originate from high\u2010endemic countries. Mortality rates are notably high among those with chronic infections, and immigrants are less likely to engage in screening and treatment services. This paper aims to assess the cost\u2010utility of screening and treating Hepatitis D Virus (HDV)\u2010positive immigrants in Canada compared with a scenario in which no screening is conducted. This analysis takes a public\u2010payer perspective, uses a lifetime time horizon with a 1.5% annual discount rate, and expresses costs in 2023 Canadian dollars. A state\u2010transition model representing the natural progression of chronic hepatitis B and hepatitis D was developed in TreeAge Pro and mapped onto three interventions: screening and treatment with bulevirtide; screening and treatment with pegylated interferon alfa\u20102a; and screening and treatment with both bulevirtide and pegylated interferon alfa\u20102a. The analysis was conducted in accordance with the guidelines of Canada's Drug Agency. The incremental cost\u2010effectiveness ratio (ICER) was estimated for each intervention. Model sensitivity was performed using both univariate and probabilistic sensitivity analyses. All screening and treatment strategies resulted in a reduction in cases of decompensated cirrhosis, hepatocellular carcinoma and liver death, with combination therapy demonstrating the most favourable outcomes. Nevertheless, HDV screening and treatment with pegylated interferon alfa\u20102a monotherapy was the only cost\u2010effective strategy (ICER: $23,177\/QALY). While monotherapy with pegylated interferon alfa\u20102a proved cost\u2010effective, combination therapy with bulevirtide is likely more clinically effective and may be cost\u2010effective if treatment costs decrease significantly.<\/jats:p>","DOI":"10.1111\/jvh.70214","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T01:19:41Z","timestamp":1784510381000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["An Exploratory Cost\u2010Utility Analysis of Screening and Treating Immigrants in Canada for Hepatitis D"],"prefix":"10.1111","volume":"33","author":[{"given":"Jiahao","family":"Zhao","sequence":"first","affiliation":[{"name":"School of Pharmacy University of Waterloo  Kitchener Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4227-7550","authenticated-orcid":false,"given":"Diedron","family":"Lewis","sequence":"additional","affiliation":[{"name":"School of Pharmacy University of Waterloo  Kitchener Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6891-8721","authenticated-orcid":false,"given":"John\u2010Michael","family":"Gamble","sequence":"additional","affiliation":[{"name":"School of Pharmacy University of Waterloo  Kitchener Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2486-4781","authenticated-orcid":false,"given":"Zahid A.","family":"Butt","sequence":"additional","affiliation":[{"name":"School of Public Health Sciences University of Waterloo  Waterloo Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William W. 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