Cost-effectiveness of routine screening for blood-borne pathogens beforeelective ophthalmic surgery in China-Supplementary materials

Xiaotong Han(韩晓彤); Jiaqing Zhang(张佳晴); Zhuoru Zou(邹卓如); Yueye Wang(王悦叶); Wei Wang(王伟); Xiaoxun Gu(古晓勋); Xiaoting Ruan(阮晓婷); Xiaoyun Chen(陈晓云); Guangming Jin(靳光明); Lanhua Wang(王兰花); Ye Dai(戴烨); Grainne Crealey; Mingguang He(何明光); Nathan Congdon; Lei Zhang(张磊); Lixia Luo(罗莉霞); Yizhi Liu(刘奕志)

Cost-effectiveness of routine screening for blood-borne pathogens beforeelective ophthalmic surgery in China-Supplementary materials

Views:: 21
Publication Date:: 2026/09/28
Author(s):: Xiaotong Han(韩晓彤)¹, Jiaqing Zhang(张佳晴)¹, Zhuoru Zou(邹卓如)², Yueye Wang(王悦叶)³, Wei Wang(王伟)¹, Xiaoxun Gu(古晓勋)¹, Xiaoting Ruan(阮晓婷)¹, Xiaoyun Chen(陈晓云)¹, Guangming Jin(靳光明)¹, Lanhua Wang(王兰花)¹, Ye Dai(戴烨)¹, Grainne Crealey⁴, Mingguang He(何明光)^1,3,5, Nathan Congdon^1,6,7, Lei Zhang(张磊)^8,9, Lixia Luo(罗莉霞)¹, Yizhi Liu(刘奕志)¹

Xiaotong Han(韩晓彤)¹, Jiaqing Zhang(张佳晴)¹, Zhuoru Zou(邹卓如)², Yueye Wang(王悦叶)³, Wei Wang(王伟)¹, Xiaoxun Gu(古晓勋)¹, Xiaoting Ruan(阮晓婷)¹, Xiaoyun Chen(陈晓云)¹, Guangming Jin(靳光明)¹, Lanhua Wang(王兰花)¹, Ye Dai(戴烨)¹, Grainne Crealey⁴, Mingguang He(何明光)^1,3,5, Nathan Congdon^1,6,7, Lei Zhang(张磊)^8,9, Lixia Luo(罗莉霞)¹, Yizhi Liu(刘奕志)¹

Institution/Unit:

State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science; Guangdong Basic Research Center of Excellence for Major Blinding Eye Diseases Prevention and Treatment; Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
China-Australia Joint Research Centre for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an 710061, China
School of Optometry, The Hong Kong Polytechnic University, Hong Kong, China
Clinical Costing Solutions, Belfast, UK
Research Centre for SHARP Vision, The Hong Kong Polytechnic University, Hong Kong, China
Centre for Public Health, Queen’s University Belfast, Belfast BT12 6BA, UK
Orbis International, New York, NY 10018, USA
Central Clinical School, Faculty of Medicine, Monash University, Melbourne 3004, Australia
Melbourne Sexual Health Centre, Alfred Health, Melbourne 3053, Australia

Keywords

preoperative testing surgery China blood-borne pathogens Cost effectiveness

Abstract

No abstract available.

Article

Supplementary Figure

Figure S1. Markov model demonstrating HBV disease progression through various disease stages.[1]

CHB = chronic hepatitis B; HBV = Hepatitis B virus; HCC = Hepatocellular carcinoma.

Figure S2. Markov model demonstrating HCV disease progression through various disease stages.

CHC = chronic hepatitis C; HCV = Hepatitis C virus; HCC = Hepatocellular carcinoma.

Figure S3. Markov model demonstrating syphilis disease progression through various disease stages.

Red lines showed the disease progression with treatment.

Green lines showed neurological symptoms and development of neurosyphilis.

Figure S4. Markov model demonstrating HIV disease progression through various disease stages

Patients entering the model were distributed into one of the four CD4⁺ based health states depending on their baseline CD4⁺ level. Based on their response to diagnosis/treatment, they were stratified in one of the four response states, including undiagnosed, treatment success, off therapy (failed virological suppression/ treat discontinuation), and death.

ART = antiretroviral therapy; HIV = human immunodeficiency virus.

Supplementary Table

Table S1. The rate of Hepatitis B virus infection status in the Chinese population, stratified by age group (1/100,000)[1]

Age, years	Chronic hepatitis B Carrier	Chronic infection	Compensated cirrhosis	Deompensated cirrhosis	Hepatocellular carcinoma
1	210.00	200.00	20.00	29.00	8.13
2	380.00	230.00	60.00	32.00	9.07
3	450.00	250.00	60.00	36.00	10.00
4	580.00	260.00	70.00	37.00	10.40
5	200.00	270.00	70.00	38.00	10.67
6	740.00	280.00	80.00	40.00	11.20
7	810.00	300.00	80.00	43.00	12.13
8	930.00	310.00	90.00	44.00	12.40
9	960.00	320.00	90.00	46.00	12.80
10	1020.00	340.00	90.00	48.00	13.60
11	1230.00	410.00	120.00	58.00	16.40
12	1410.00	470.00	130.00	67.00	18.80
13	1570.00	520.00	150.00	75.00	20.93
14	1760.00	590.00	170.00	84.00	23.47
15	1900.00	630.00	180.00	90.00	25.33
16	2030.00	680.00	190.00	96.00	27.07
17	2100.00	700.00	200.00	100.00	28.00
18	2170.00	723.30	206.20	103.10	94.00
19	2331.00	777.00	221.40	110.70	94.00
20	2504.00	834.67	237.90	118.90	94.00
21	2618.00	872.70	248.70	124.40	94.00
22	2865.00	955.00	272.10	136.10	94.00
23	3050.00	1017.00	289.80	144.90	94.00
24	3226.00	1075.00	306.50	153.20	94.00
25	3381.00	1127.00	321.20	160.60	94.00
26	3566.00	1188.70	338.80	169.40	94.00
27	3711.00	1237.00	352.50	176.30	94.00
28	3878.00	1293.00	368.40	184.20	94.00
29	4015.00	1338.00	381.40	190.70	94.00
30	4110.00	1370.00	390.45	195.20	221.99
31	4187.50	1396.00	397.80	198.90	221.99
32	4256.60	1419.00	404.40	202.20	221.99
33	4328.10	1442.70	411.20	205.60	221.99
34	4398.10	1466.00	417.80	208.90	221.99
35	4467.30	1489.10	424.40	212.20	221.99
36	4536.20	1512.00	430.90	215.50	221.99
37	4605.00	1535.00	437.50	218.70	221.99
38	4676.70	1558.90	444.29	222.10	221.99
39	4748.10	1582.70	451.07	225.50	221.99
40	4819.00	1606.33	457.81	228.90	286.50
41	4875.10	1625.00	463.13	231.60	286.50
42	4950.00	1651.00	470.25	235.10	286.50
43	4978.70	1659.60	472.98	236.50	286.50
44	5049.00	1683.00	479.66	239.80	286.50
45	5096.00	1699.00	484.12	242.10	286.50
46	5141.00	1714.00	488.40	244.20	286.50
47	5192.00	1731.00	493.24	246.60	286.50
48	5247.00	1749.00	498.47	249.20	286.50
49	5299.00	1766.00	503.41	251.70	286.50
50	5344.00	1781.33	507.68	253.80	363.80
51	5371.00	1790.30	510.25	255.10	363.80
52	5389.00	1796.33	511.96	256.00	363.80
53	5410.04	1803.35	513.95	257.20	363.80
54	5438.72	1812.90	516.68	258.30	363.80
55	5447.40	1815.80	517.50	258.80	363.80
56	5462.08	1820.69	518.90	259.40	363.80
57	5479.76	1826.60	520.60	260.30	363.80
58	5499.44	1833.15	522.40	261.20	363.80
59	5518.12	1839.37	524.22	262.10	363.80
60	5533.80	1844.60	525.71	262.90	363.80
61	5551.48	1850.49	527.39	263.70	363.80
62	5569.16	1856.39	529.07	264.50	363.80
63	5586.84	1862.28	530.75	265.40	363.80
64	5604.52	1868.17	532.43	266.20	363.80
65	5620.20	1873.40	533.92	267.00	363.80
66	5639.88	1879.96	535.80	267.90	363.80
67	5655.56	1885.00	537.30	268.60	363.80
68	5671.24	1890.00	538.80	269.40	363.80
69	5696.92	1898.97	541.20	270.60	363.80
70	5710.60	1903.50	542.50	271.30	363.80

Table S2. Possibility of vaccination for Hepatitis B virus in Chinese population, by age[1]

Age, years	Rate
18	0.9518
19	0.7210
20	0.6843
21	0.6516
22	0.6104
23	0.5587
24	0.5036
25	0.4517
26	0.4115
27	0.3723
28	0.3451
29	0.3117
30	0.2816
31	0.2690
32	0.2508
33	0.2372
34	0.2151
35	0.2006
36	0.1846
37	0.1674
38	0.1528
39	0.1363
40	0.1294
41	0.1187
42	0.1095
43	0.1012
44	0.0944
45	0.0871
46	0.0785
47	0.0672
48	0.0587
49	0.0502
50	0.0431
51	0.0395
52	0.0362
53	0.0331
54	0.0304
55	0.0281
56	0.0254
57	0.0228
58	0.0193
59	0.0174
60	0.0157
61	0.0150
62	0.0150
63	0.0150
64	0.0150
65	0.0150
66	0.0150
67	0.0150
68	0.0150
69	0.0150
70	0.0150

Table S3. Overview of annual transition rates for progression following screening and natural progression of HBV

Initial State	Transition State	Natural progression	Source
Unprotected	Acute hepatitis B	0.0083	^[1]
CHB carrier	Inactive chronic infection	0.015 (0-0.05)	^[2^,^3]
Inactive CHB	Delayed clearance	0.01 (0.005-0.02)	^[4-6]
	CHB	20-39 years 0.0023 ±50% ≥40 years 0.0054 ±50%	^[2^,³^,^7-9]
	Compensated cirrhosis	0.029 (0.015-0.058)	^[10]
	HCC	20-39 years 0.002 ±50% ≥40 years 0.0061 ±50%	^[3^,⁷^,⁹^,^{11 12]}
Compensated cirrhosis	Decompensated cirrhosis	0.073 (0.03-0.1)	^[13-18]
	HCC	0.034 (0.01-0.1)	^[11^,¹⁵^,^18-22]
	HBV-related death	0.031 (0.031-0.038)	^[11^,^23]
Decompensated cirrhosis	HCC	0.034 (0.01-0.1)	^[11^,¹⁵^,^18-22]
	HBV-related death	0.17 (0.1-0.25)	^[11^,¹⁸^,^24-26]
HCC	HBV-related death	0.45 (0.22-0.7)	^[15^,¹⁹^,²⁶^-^27]
CHB = chronic hepatitis B; HBV = Hepatitis B virus; HCC = Hepatocellular carcinoma.

Table S4. Treatment-related annual transition estimates of Hepatitis B virus infection

Initial State	Transition State		Estimates	Source
CHB initial therapy		Sustained virologic response	0.39 (0.15-0.75)	^[18]
		Cirrhosis	0.002 (0.001-0.002)	^[28]
		HCC	0.002 (0.001-0.005)	^[29]
CHB long-term therapy		Sustained virologic response	0.797 (0.17-0.96)	^[30]
		Cirrhosis	0.002 (0.001-0.002)	^[28]
		HCC	0.012 (0.01-0.014)	^[31]
Cirrhosis therapy		Sustained virologic response	0.30 (0.24-0.875)	^[32^-^33]
		Decompensated cirrhosis	0.019 (0.009-0.046)	^[28^,^32]
		HCC	0.02 (0.016-0.044)	^[31^,^34]
		HBV-related death	0.017 (0.012-0.048)	^[35-38]
Decompensated cirrhosis therapy		HCC	0.024 (0.006-0.081)	^[29^,³⁴^,^39]
		Liver transplantation	0.017 (0.001-0.042)	^[28^,^40]
		HBV-related death	0.095(0.056-0.14)	^[35]
HCC therapy		Liver transplantation	0.006 (0.001-0.03)	^[28^,^40]
		HBV-related death	0.26 (0.25-0.27)	^[41]
CHB = chronic hepatitis B; HCC = Hepatocellular carcinoma.

Table S5. Costs estimates of Hepatitis B virus infection

Items	US$ (2022)	Source
Screening cost (per item)
Hepatitis B surface antigen rapid test	2.76	-
Hepatitis B “five tests” HBsAg/HBsAb/HBeAg/HBeAb/HBcAb	13.78	-
Test cost (per item)
Liver function test	3.17	-
Hepatitis B virus DNA test	12.41	-
Hepatocellular carcinoma test	20.68	-
Vaccination for adults (per item)	4.55	^[42]
Average annual direct medical and non-medical cost at various infection stages
Chronic hepatitis B	2662.76	^[43]
Compensated cirrhosis	4178.04
Decompensated cirrhosis	4567.30
Hepatocellular carcinoma	7044.67
Liver transplantation	34445.41	^[43^-^44]

Table S6. Other parameters used in the HBV model

Parameter	Base-case	Range	Source
Vaccine
Efficacy against HBV infection	97.9%	97.6%-98.2% in China study 90-95% in France study	^[45^-^46]
Probability of symptom-based case-finding
Chronic HBV infection	0.12		^[1]
Compensated cirrhosis	0.15		^[1]
Decompensated cirrhosis	0.40		^[1]
Hepatocellular carcinoma	0.60		^[1]
HbsAg/HbsAb
Sensitivity	0.932	0.851-0.985	^[47]
Specificity	0.931	0.851-0.999	^[47]
HBsAg/HBsAb/HBeAg/HBeAb/HBcAb
Sensitivity	0.955	0.889-0.994	^[47]
Specificity	0.998	0.993-1.000	^[47]
HBV-related death rate
HBV-related Cirrhosis mortality rate	5.9 (/100,000) in 2016		^[48]
HBV-related liver cancer mortality rate	17.76 (/100,000) in 2015	16.92-18.61	^[49-52]
Liver transplant
Cases	4732 cases in 2017		^[44]
Proportion of HBV-related diseases among LT	80%		^[53]
Utility score
Viral suppression	1.00	0.95-1.00	^[54]
Seroclearance	0.99	0.90-1.00	^[54]
Inactive chronic HBV infection	0.79	0.74-0.84	^[55]
Compensated cirrhosis	0.73	0.69-0.78	^[55]
Decompensated cirrhosis	0.65	0.63-0.67	^[55]
Hepatocellular carcinoma	0.38	0.36-0.41	^[55]
Liver transplantation	0.67	0.64-0.69	^[54]
HBV = Hepatitis B virus.

Table S7. The rate of Hepatitis C virus infection status in the Chinese population, stratified by age group (1/100,000)[56-57]

Age, yrs	CHC carrier	Chronic infection	Compensated cirrhosis	Decompensated cirrhosis	Hepatocellular carcinoma
20-24 years	1328.9724	0.7861	0.1100	0.1079	0.0236
25-29 years	1357.2610	2.0953	0.2931	0.2876	0.0630
30-34 years	1393.1480	5.2418	0.7332	0.7195	0.1580
35-39 years	1400.6070	14.8357	2.0751	2.0363	0.4460
40-44 years	1404.1448	35.0792	4.9065	4.8148	1.0500
45-49 years	1387.1278	55.7472	7.7973	7.6516	1.6800
50-54 years	1373.7813	96.5573	13.5054	13.2530	2.9000
55-59 years	1323.0674	158.3034	22.1418	21.7279	4.7600
60-64 years	1246.1583	232.43894	32.5111	31.9034	6.9884
65-70 years	1151.7330	319.9742	44.7546	43.9180	9.6200
CHC = chronic hepatitis C.

Table S8. Natural and treatment-related annual transition estimates of Hepatitis C virus infection

Initial State	Transition State	1-year transition probability		Source
Initial State	Transition State			Source	Natural course	After treatment
Unprotected	Remain Unprotected	99.85%	-	^[58^-^59]
	CHC carrier	0.0105%	-	^[58^-^59]
	Chronic infection	0.0045%	-	^[58^-^59]
CHC carrier	Remain CHC carrier	84.3%	-	^[60]
	Chronic infection	13.6%	-	^[60]
	Resolved infection	2.1%	-
Chronic infection	Remained Chronic infection	94.9%	6%	^[60^-^61]
	Resolved infection	0.5%	94%	^[60^-^61]
	Compensated cirrhosis	4.6%	0	^[60^-^61]
Compensated cirrhosis	Remain Compensated cirrhosis	-	-
	Resolved infection	0	8.6%	^[62]
	Decompensated cirrhosis	4.8%	0.2%	^[63]
	HCC	4.2%	0.5%	^[60^,^63]
	Death	0	0	^[63]
Decompensated cirrhosis	Remain Decompensated cirrhosis	78.59%	97%	^[61^,^63]
	HCC	7.5%	1.05%	^[61^,^63]
	Liver transplantation	2.11%	0.3%	^[61^,^63]
	Death	11.8%	1.65%	^[61^,^63]
HCC	Remain HCC	65.89%	95.5%	^[61^,^63]
	Liver transplantation	2.11%	0.28%	^[61^,^63]
	Death	32%	4.22%	^[61^,^63]
CHC = chronic hepatitis C; HCC = Hepatocellular carcinoma.

Table S9. Costs estimates of Hepatitis C virus infection

Items	US$ (2022)	Source
Screening cost (per item)
Hepatitis C virus antibody test	2.76	-
Test cost (per item)
Hepatitis C virus RNA test	34	^[64]
Genotyping test	84	^[64]
Liver function test	3.17	-
Hepatocellular carcinoma test	20.68	-
Average annual cost at various infection stages
Chronic hepatitis C infection	1162	^[65]
Compensated cirrhosis	3306	^[65]
Decompensated cirrhosis	7364	^[65]
Hepatocellular carcinoma	15543	^[65]
Liver transplantation	62413	^[66]
Post Liver transplantation	9921	^[66]

Table S10. Other parameters used in the Hepatitis C virus model

Parameter	Base-case	Range	Source
Screening test
Sensitivity	0.973	0.955-0.984	^[67]
Specificity	0.989	0.980-0.994	^[67]
Utility score
Chronic hepatitis C carrier	0.93	0.90-0.96	^[68]
Chronic hepatitis C infection	0.70	0.63-0.76	^[68]
Compensated cirrhosis	0.55	0.48-0.65	^[68]
Decompensated cirrhosis	0.45	0.48-0.61	^[68]
Hepatocellular carcinoma	0.45	0.48-0.61	^[68]
Liver transplantation	0.56	0.52-0.78	^[69^-^70]
Post Liver transplantation	0.71	0.57-0.85	^[69^-^70]

Table S11. The rate of syphilis infection status in the Chinese population, stratified by age group (1/100,000)[71-73]

Age, years	Primary syphilis	Secondary syphilis	Early latent syphilis	Late latent syphilis	Untreated tertiary syphilis
18	10.73	12.87	0.94	139.14	0.66
19	10.73	12.87	0.94	139.14	0.66
20	10.73	12.87	0.94	139.14	0.66
21	10.73	12.87	1.87	138.21	0.66
22	10.73	12.87	1.87	138.21	0.66
23	10.73	12.87	1.87	138.21	0.66
24	10.73	12.87	1.87	138.21	0.66
25	17.78	21.34	1.87	230.42	1.09
26	17.78	21.34	3.30	228.99	1.09
27	17.78	21.34	3.30	228.99	1.09
28	17.78	21.34	3.30	228.99	1.09
29	17.78	21.34	3.30	228.99	1.09
30	17.78	21.34	3.30	228.99	1.09
31	17.78	21.34	3.75	228.54	1.09
32	17.78	21.34	3.75	228.54	1.09
33	17.78	21.34	3.75	228.54	1.09
34	17.78	21.34	3.75	228.54	1.09
35	35.48	42.57	3.75	459.64	2.18
36	35.48	42.57	2.83	460.55	2.18
37	35.48	42.57	2.83	460.55	2.18
38	35.48	42.57	2.83	460.55	2.18
39	35.48	42.57	2.83	460.55	2.18
40	35.48	42.57	2.83	460.55	2.18
41	35.48	42.57	2.56	460.82	2.18
42	35.48	42.57	2.56	460.82	2.18
43	35.48	42.57	2.56	460.82	2.18
44	35.48	42.57	2.56	460.82	2.18
45	40.42	48.50	2.56	460.82	2.49
46	40.42	48.50	2.75	525.15	2.49
47	40.42	48.50	2.75	525.15	2.49
48	40.42	48.50	2.75	525.15	2.49
49	40.42	48.50	2.75	525.15	2.49
50	40.42	8.08	2.75	525.15	2.49
51	18.65	8.08	4.68	586.03	4.35
52	18.65	8.08	4.68	586.03	4.35
53	18.65	8.08	4.68	586.03	4.35
54	18.65	8.08	4.68	586.03	4.35
55	18.65	8.08	4.68	586.03	4.35
56	18.65	8.08	3.09	587.62	4.35
57	18.65	8.08	3.09	587.62	4.35
58	18.65	8.08	3.09	587.62	4.35
59	18.65	8.08	3.09	587.62	4.35
60	18.65	8.08	3.09	587.62	4.35
61	18.65	8.08	4.61	586.11	4.35
62	18.65	8.08	4.61	586.11	4.35
63	18.65	8.08	4.61	586.11	4.35
64	18.65	8.08	4.61	586.11	4.35
65	18.65	8.08	4.61	586.11	4.35
66	18.65	8.08	5.64	585.07	4.35
67	18.65	8.08	5.64	585.07	4.35
68	18.65	8.08	5.64	585.07	4.35
69	18.65	8.08	5.64	585.07	4.35
70	18.65	8.08	5.64	585.07	4.35

Table S12. Age-related incidence of syphilis (1/100,000)[73]

Age	Incidence
18	9.4241
19	9.4241
20	9.4241
21	18.7073
22	18.7073
23	18.7073
24	18.7073
25	18.7073
26	32.9777
27	32.9777
28	32.9777
29	32.9777
30	32.9777
31	37.4686
32	37.4686
33	37.4686
34	37.4686
35	37.4686
36	28.3134
37	28.3134
38	28.3134
39	28.3134
40	28.3134
41	25.608
42	25.608
43	25.608
44	25.608
45	25.608
46	27.5347
47	27.5347
48	27.5347
49	27.5347
50	27.5347
51	46.828
52	46.828
53	46.828
54	46.828
55	46.828
56	56.4094
57	56.4094
58	56.4094
59	56.4094
60	56.4094
61	62.9857
62	62.9857
63	62.9857
64	62.9857
65	62.9857
66	62.9295
67	62.9295
68	62.9295
69	62.9295
70	62.9295

Table S13. Natural and treatment-related annual transition estimates of syphilis infection

Initial State		Transition State	1-year transition probability		Source
Initial State		Transition State			Source	No treatment	After treatment
Primary syphilis	Remain		0	0	^[74-77]
	Secondary syphilis		40%	9.4%	^[74-77]
	Treated with no sequelae		-	90%	^[74-77]
	Early neurosyphilis		60%	0.6%	^[74-77]
Secondary syphilis	Remain		0	0	^[74-77]
	Early latent syphilis		40%	9.4%	^[74-77]
	Treated with no sequelae		-	90%	^[74-77]
	Early neurosyphilis		60%	0.6%	^[74-77]
Early latent syphilis	Remain		0	0	^[74-77]
	Late latent syphilis		40%	9.4%	^[74-77]
	Treated with no sequelae		-	90%	^[74-77]
	Early neurosyphilis		60%	0.6%	^[74-77]
Late latent syphilis	Remain		75%	-	^[74^,^76-79]
	Tertiary syphilis		24.4%	-	^[74^,^76-79]
	Late neurosyphilis		0.6%	-	^[74^,^76-79]
Early neurosyphilis	Remain		98.56%	8.56%	^[75^,^78-80]
	Tertiary syphilis		1.44%	1.44%	^[75^,^78-80]
	Treated with no sequelae		-	90%	^[75^,^78-80]
*Neuro involvement can coexist with other infection status; thus, the total rate may exceed 100%.

Table S14. Costs estimates of Syphilis infection[81]

Items	US$ (2022)
Screening cost
Syphilis screening	8.27
Syphilis confirmation test	20.68
Average annual cost at various infection stages
Early syphilis (including primary, secondary, early latent)	736.87
Late syphilis	1117.82

Table S15. Other parameters used in the syphilis model

Parameter	Base-case	Range	Source
Screening test sensitivity
Primary syphilis	0.93	0.77-1	^[78]
Secondary syphilis	1	0.95-1	^[78]
Early latent syphilis	1	0.95-1	^[78]
Late latent syphilis	0.99	0.94-1	^[78]
Percentage of having symptoms
Primary syphilis	1.7%		^[82]
Secondary syphilis	1.7%		^[82]
Early latent syphilis	1.7%		^[82]
Late latent syphilis	0		^[74]
Tertiary syphilis	30%		^[76]
Early neurosyphilis	70%		^[74]
Late neurosyphilis	5%		^[74]
Possibility of seeking treatment
Primary syphilis	35%		^[78^,^82]
Secondary syphilis	60%		^[78]
Early latent syphilis	100%
Late latent syphilis	0		^[74]
Tertiary syphilis	19%		^[75]
Early neurosyphilis	60%		^[74]
Late neurosyphilis	19%		^[75]
Possibility of successful treatment
Primary syphilis	90%		^[77]
Secondary syphilis	90%		^[77]
Early latent syphilis	90%		^[77]
Late latent syphilis	0		^[74]
Tertiary syphilis	77%		^[80]
Early neurosyphilis	90%		^[77]
Late neurosyphilis	77%		^[80]
Utility score
Primary syphilis	0.994	0.99-0.996	^[75]
Secondary syphilis	0.96	0.94-0.98	^[75]
Early latent syphilis	1	-	^[75]
Late latent syphilis	1	-	^[75]
Tertiary syphilis	0.76	0.67-0.75	^[75]
Early neurosyphilis	0.95	0.92-0.97	^[75]
Late neurosyphilis	0.80	0.71-0.88	^[75]

Table S16. The proportion of HIV infection status in the Chinese population, stratified by age group (1/100,000)[83-84]

Age, years	HIV+ CD4≥500	HIV+ 350≤CD4<500	HIV+ 200≤CD4<350	HIV+ CD4<200
18-24	7.80	18.00	19.98	14.22
25-29	7.80	13.20	22.38	16.62
30-34	27.08	61.60	86.80	104.44
35-39	12.12	47.60	98.84	121.24
40-44	8.70	43.50	97.73	140.07
45-49	14.50	48.43	87.00	111.07
50-59	9.32	38.68	138.80	213.20
60-69	12.35	51.25	183.91	282.49
≥70	7.22	29.98	107.57	165.23
HIV = human immunodeficiency virus.

Table S17. Age-related incidence of human immunodeficiency virus infection (1/100,000)[73]

Age, years	Incidence
18-19	4.6312
20-24	10.3240
25-29	17.9733
30-34	20.2556
35-39	15.1946
40-44	13.8324
45-49	13.1898
50-54	20.8168
55-59	12.8898
60-64	18.8789
65-69	18.8143
70-74	15.3597
75-79	11.7542
80-84	8.3400
≥85	5.6229

Table S18. Natural and treatment-related annual transition estimates of human immunodeficiency virus infection[85-86]

Initial State	Transition State	1-year transition probability
Initial State	Transition State			Natural course	After treatment
CD4<200	Remain CD4<200		-
	200≤CD4<350	0.20	0.37
	350≤CD4<500	0.07	0.17
	CD4≥500	0.03	0.04
200≤CD4<350	Remain 200≤CD4<350	-	-
	CD4<200	0.13	0.09
	350≤CD4<500	0.24	0.34
	CD4≥500	0.13	0.14
350≤CD4<500	Remain 350≤CD4<500	-	-
	CD4<200	0.03	0.02
	200≤CD4<350	0.20	0.17
	CD4≥500	0.32	0.36
CD4≥500	Remain CD4≥500	-	-
	CD4<200	0.01	0.01
	200≤CD4<350	0.05	0.03
	350≤CD4<500	0.18	0.16

Table S19. Costs estimates of HIV screening and treatment[87]

Variables	Base value (2022 $)
Test costs per person screened	25.4
Additional screening-related costs if positive	44
Confirmatory Western blot test	86.0
CD4 count test	49.3
Viral load test	308.4
Annual treatment costs
Cost of ART	545.2
Non-ART medical costs
CD4≥500	3005.9
350≤CD4<500	3005.9
200≤CD4<350	7391.6
CD4<200	9661.4
ART = antiretroviral therapy; HIV = human immunodeficiency virus.

Table S20. Other parameters used in the HIV model

Parameter	Base-case	Range	Source
Screening test			^[88]
Sensitivity	0.9521	0.9078-0.9791%
Specificity	0.9995	0.9983-0.9999
Probability of symptom-based case-finding			^{[89 90]}
CD4≥500	0.050	0.034-0.085
350≤CD4<500	0.073	0.058-0.112
200≤CD4<350	0.154	0.146-0.451
CD4<200	0.872	0.216-1.000
The rate of failed virological suppression/ treat discontinuation			^[87]
CD4≥500	0.00361	-
350≤CD4<500	0.00320	-
200≤CD4<350	0.00392	-
CD4<200	0.00431	-
Utility values			^[91]
CD4≥500	0.94	0.92-1.00
350≤CD4<500	0.89	0.80-1.00
200≤CD4<350	0.83	0.45-1.00
CD4<200	0.73	0.24-0.80

Table S21. Age-related death rate (1/100,000)

Age/years	Background death^[92]	Syphilis related death^[75]	HIV-related death with treatment^[93]	HIV-related death without treatment^[93]
18	41	70	996	5929
19	43	70	1044	6218
20	47	70	1142	6796
21	47	70	1142	6796
22	50	70	1214	7230
23	54	70	1312	7809
24	56	84	1360	8098
25	58	84	1409	8387
26	57	84	1384	8243
27	59	84	1433	8532
28	61	84	1482	8821
29	68	84	1652	9833
30	70	172	1700	10122
31	77	172	1870	11135
32	81	172	1967	11713
33	83	172	2016	12002
34	94	172	2283	13593
35	103	355.2	1219	7256
36	106	355.2	1254	7468
37	114	355.2	1349	8031
38	121	355.2	1432	8524
39	134	355.2	1586	9440
40	151	646.2	1787	10638
41	155	646.2	1834	10920
42	182	646.2	2154	12822
43	189	646.2	2237	13315
44	207	646.2	2450	14583
45	231	928.2	2734	16274
46	236	928.2	2793	16626
47	254	928.2	3006	17894
48	310	928.2	3668	21839
49	328	928.2	3881	23108
50	364	1667.4	1792	10666
51	375	1667.4	1846	10989
52	398	1667.4	1959	11663
53	441	1667.4	2171	12923
54	498	1667.4	2451	14593
55	518	1264.8	2550	15179
56	564	1264.8	2776	16527
57	609	1264.8	2998	17846
58	681	1264.8	3352	19956
59	767	1264.8	3775	22476
60	854	1102.1	4203	25025
61	938	1102.1	4617	27487
62	1038	1102.1	5109	30417
63	1112	1102.1	5473	32585
64	1301	1102.1	6404	38124
65	1421	5263.2	3316	19740
66	1474	5263.2	3439	20477
67	1723	5263.2	4020	23936
68	1864	5263.2	4349	25894
69	2191	5263.2	5112	30437
70	2557	3794.4	5966	35521
71	2673	3794.4	6237	37133
72	3094	3794.4	7220	42981
73	3359	3794.4	7838	46663
74	3744	3794.4	8736	52011
75	4151	6138	9686	57665
76	4219	6138	9845	58610
77	5097	6138	11893	70807
78	5620	6138	13114	78072
79	6212	6138	14495	86296
80	7428	6138	17332	100000
81	7791	6138	18179	100000
82	8581	6138	20023	100000
83	9352	6138	21822	100000
84	10363	6138	24181	100000
85	11100	6138	25901	100000
86	11888	6138	27739	100000
87	13007	6138	30350	100000
88	14418	6138	33643	100000
89	15687	6138	36604	100000
90	17652	6138	41189	100000
91	18524	6138	43224	100000
92	20211	6138	47160	100000
93	20735	6138	48383	100000
94	20891	6138	48747	100000
95	22001	6138	51337	100000
96	22099	6138	51566	100000
97	20484	6138	47797	100000
98	19813	6138	46232	100000
99	25765	6138	60120	100000
100	45435	6138	100000	100000
HIV = human immunodeficiency virus.

Literature search strategy (Pubmed)

1. (((((((((hepatitis B[MeSH Terms]) OR (hepatitis C[MeSH Terms])) OR (HBV[MeSH Terms])) OR (HCV[MeSH Terms])) OR (HIV[MeSH Terms])) OR (human immunodeficiency virus[MeSH Terms])) OR (Acquired Immune Deficiency Syndrome[MeSH Terms])) OR (AIDS[MeSH Terms])) OR (syphilis[MeSH Terms])) OR (Treponema pallidum[MeSH Terms])

2. (((((((((((hepatitis B) OR (HBV)) OR (CHB)) OR (hepatitis C)) OR (HCV)) OR (CHC)) OR (AIDS)) OR (human immunodeficiency virus)) OR (acquired immune deficiency syndrome)) OR (HIV)) OR (syphilis)) OR (treponema pallidum)

3. 1 OR 2

4. ((((((((((cost-effectiveness) OR (cost-effective)) OR (cost-benefit)) OR (cost-utility)) OR (economic modelling)) OR (ICER)) OR (ICUR)) OR (Markov model)) OR (economic evaluation)) OR (economic analysis)) OR (QALY)

5. (((screening) OR (screen)) OR (detection)) OR (diagnosis)

6. ((((pre-surgical) OR (preoperative)) OR (surgery)) OR (operation)) OR (surgical)

7. 3 AND 4 AND 5 AND 6

Funding

No Fund Information

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Cost-effectiveness of routine screening for blood-borne pathogens beforeelective ophthalmic surgery in China-Supplementary materials

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