Health economic evaluation of universal infant hepatitis B vaccination programmes in China

Abstract

Introduction: China has about 120 million hepatitis B virus (HBV) carriers and a 7.2% hepatitis B surface antigen (HBsAg) prevalence in 2006.This creates a huge disease burden and also leads to significant economic losses. Since 2002, a free universal infant hepatitis B vaccination programme has provideda 3-dose primary vaccination for all infants. Although some economic evaluations of this programme have been conducted, a comprehensive cost-effectiveness analysis (CEA) to estimate long-term benefit using mathematical modeling would aid understanding of population strategies for hepatitis B control in large populations. Moreover, the most common mode of infection is perinataltransmission at birth. However the more effective immunization programme involving screening women during pregnancy for HBV-carrier status and providing passive-active vaccination for newborns has not been implemented in China. Aims: To identify the most cost-effective universal infant hepatitis B vaccination strategy for China. Method: A hospital-based survey was conducted during 2010-2011 in a general hospital in Shenzhen, China, in order to obtain costing data to estimate the economic burden of chronic hepatitis B patients. Annual direct and indirect costs from this study were used as cost parameters in the CEA models. Mathematical models were developed to simulate perinatal transmission, vaccination programmes and disease progression using Markov modeling and decision trees. Quality-adjusted life year (QALYs) as well as health and monetary outcomes were also assessed. Univariate sensitivity analysis and probabilistic sensitivity analysis using Monte Carlo simulation were performed to test parameter uncertainty. Two programmes of screening of pregnant women for both HBsAg and/or HBeAg and the infant passive-active vaccination were compared with the current vaccine-only programme in one CEA, while the other CEA estimated the effect of the current infant programme compared with no vaccination. Findings: The estimated total economic burden including annual direct and indirect cost among hepatitis B patients of RMB 43104.5 (US$6340.8). The economic burdens of associated disease states of hepatitis B infection were highest for hepatocellular carcinoma (HCC) (RMB 77297.1), decompensated cirrhosis (RMB 50725.7), chronic active hepatitis B (CAH) (RMB 37449.5) and finally compensated cirrhosis (RMB 37276.9). The average total economic burden per hepatitis B patient amounted to 46% of Shenzhen GDP per capitain 2010, and 5.4% of the city’s annual per capita income. The current vaccine-only infant vaccination programme was justified by costsavings, from both a societal and health care payer’s perspective, reducing new HBV infections by about 76%. This has produced a gain of 743,000 life-years and 620,000 QALYs given current numbers and savings of US$2~3billion saved over the lifetime of a national cohortof 10,000,000 newborns. A universal control programme involving the screening of pregnant women for HBsAg and passive-active vaccination, would reduce new infections by 13%, saving 436,000 life years and gaining 121,000 QALYs for a saving of about US$546 million compared with current vaccine-only programme. Implications: The universal infant hepatitis B vaccination programme is currently a cost-effective strategy for hepatitis B control in China.A beneficial amendment to the current strategy wouldinclude screening of all pregnant women for HBsAg and vaccinating newborns in a passive-active way.