Cost-effectiveness analysis of hepatitis B vaccine booster in children born to HBsAg-positive mothers in rural China

• Published in: International journal of infectious diseases Vol. 78; pp. 130 - 139
• Main Authors: Wang, Yuting, Shi, Ju-Fang, Wang, Le, Yan, Yongfeng, Yao, Hongyu, Dai, Min, Chen, Taoyang, Qu, Chunfeng
• Format: Journal Article
• Language: English
• Published: Canada Elsevier Ltd 01.01.2019; Elsevier
• Subjects: Adolescent; Adolescent booster; Adult; Child; Child, Preschool; Cost-Benefit Analysis; Cost-effectiveness analysis; Female; Hepatitis B - epidemiology; Hepatitis B - prevention & control; Hepatitis B Antibodies - blood; Hepatitis B Surface Antigens - analysis; Hepatitis B vaccine; Hepatitis B Vaccines - administration & dosage; Hepatitis B Vaccines - immunology; Humans; Immunization, Secondary; Infant; Male; Mothers; Quality-Adjusted Life Years; Rural Health; Cost-effectiveness analysis; Hepatitis B vaccine; Adolescent booster
• ISSN: 1201-9712; 1878-3511
• DOI: 10.1016/j.ijid.2018.08.024

•Hepatitis B booster vaccination for high-risk children would be cost-effective.•Uncertainty of all variables could not change the conclusion that booster vaccination was cost-saving.•In a ‘worst case’ scenario, the cost-effectiveness ratio was still less than the GDP per capita in China in 2016. In rural areas of China with highly endemic for hepatitis B virus (HBV) infection, protective efficacy was observed in adulthood when a one-dose HBV vaccine booster was administered to high-risk children born to mothers who were positive for hepatitis B surface antigen (HBsAg). The aim of this study was to estimate the cost-effectiveness of an HBV vaccine booster in this specific group of children when given at 10 years of age. Two potential strategies were considered: strategy 1 was a one-dose booster given if the child was negative on HBsAg screening; strategy 2 was a one-dose booster given if the child was negative on both HBsAg plus anti-HBs screening. A decision tree combined with a Markov model was developed to simulate the booster intervention process and to simulate the natural history of HBV infection in a cohort of 10-year-old children who were born to HBsAg-positive mothers. The model was calibrated based on multiple selected outcomes. Costs and quality-adjusted life years (QALYs) were measured from a societal perspective. Cost-effectiveness ratios (CERs) of the different strategies were compared in both base-case and one-way sensitivity analyses. Compared to the current practice of ‘no screening and no booster’, both strategy 1 and strategy 2 were cost-saving, with CERs estimated at US$ −6961 and US$ −6872 per QALY gained, respectively. In the one-way sensitivity analysis for strategy 1, all the CERs were found to be less than US$ −5000 per QALY gained after considering the uncertainty of all the variables, including vaccination protective efficacy, natural history, behavior, and various costs and utility weights. In a ‘worst case’ scenario (all parameter values simultaneously being at the worst), the CER of strategy 1 increased to US$ 3263 per QALY gained, which was still less than the GDP per capita of China in 2016 (US$ 8126). A hepatitis B vaccine booster given to children born to HBsAg-positive mothers in rural China would be cost-effective and could be considered in HBV endemic areas.