Objective: The aim of the study was to estimate long-term cost‑effectiveness of a hepatitis B vaccination catch-up program among children born between 1994 and 2001 (when they were 8‑15 y old) in Shandong province, China, to provide information for nationwide evaluation and future policy making.
Methods: We determined the cost-effectiveness of the catch-up program compared with the status quo (no catch-up program). We combined a Decision Tree model and a Markov model to simulate vaccination and clinical progression after hepatitis B virus (HBV) infection. Parameters in the models were from the literature, a field survey, program files, and the National Notifiable Disease Reporting System (NNDRS). The incremental cost‑effectiveness ratio (ICER) was used to compare the 2 alternative strategies. One-way sensitivity analysis, 2-way sensitivity analysis, and probability sensitivity analysis were used to assess parameter uncertainties.
Results: The catch-up program was dominant compared with the status quo. Using a total of 5.53 million doses of vaccines, the catch-up program could prevent 21,865 cases of symptomatic acute hepatitis B, 3,088 carrier states with positive hepatitis B surface antigen (HBsAg), and 812 deaths due to HBV infection. The catch-up program could add 28,888 quality-adjusted life years (QALYs) and save $192.01 million in the targeted population in the future. The models were robust, considering parameter uncertainties.
Conclusion: The catch-up program in Shandong province among children born between 1994 and 2001 was 'very cost-saving.' It could save life years and reduce total future costs. Our study supported the desirability and impact of such a catch-up program throughout China.
Keywords: Anti-HBs, Antibody to Hepatitis B Surface Antigen; CC, Compensated Cirrhosis; CHB, Chronic Hepatitis B; Cost-effectiveness Analysis; DC, Decompensated Cirrhosis; GAVI, Global Alliance on Vaccines and Immunization; GDP, Gross Domestic Product; BCR, Benefit-Cost Ratio; HBV, Hepatitis B Virus; HBsAg, Hepatitis B Surface Antigen; HCC, Hepatocellular Carcinoma; HRQoL, Health-Related Quality of Life; HepB3, 3-dose Coverage of Hepatitis B Vaccine; ICER; ICER, Incremental Cost-Effectiveness Ratio; LT-1, the Year of Liver Transplantation; LT-2, Years after Liver Transplantation; MOH, Ministry of Health; NNDRS, National Notifiable Diseases Reporting System; QALY; QALYs, Quality-Adjusted Life Years; catch-up program; hepatitis B virus; vaccination.