| ObjectiveThe economic burden of hepatitis B-related diseases was substantial for patients and their families, so we organized the investigation to estimate the direct, indirect and intangible costs due to hepatitis B-related diseases and to definite main factors associated with the costs in Guangzhou. In addition, we had another purpose to explore the difference of three elicitation techniques of willingness to pay approach,which were conducted to estimate the intangible cost. The results can provide parameters for National Science and Technology Support Projects for the"Eleventh Five-Year Plan"of China. To analyze the benefit cost ratio of the hepatitis B vaccination strategies for population of 1 to14 years old in China, and selected the best hepatitis B vaccination strategy for different groups of population. And to determine the main influencing parameters on the best vaccination strategy. The study results can provide relevant departments with statistical basis for hepatitis B expanded immunization strategies making.MethodsCluster sampling for cases collected consecutively during the study period was administrated. Subiects were selected from eligible hepatitis B-related patients. By pre-trained professional investigators, health economics-related information was collected, using a structured questionnaire. Hospitalization expenses were obtained through hospital records after the patients were discharged from hospital. Total economic burden of hepatitis B-related patients would involve direct,indirect and intangible costs. Direct costs were further divided into direct medical costs and direct nonmedical costs. Human Capital Approach Was employed to measure the indirect costs both on patients and the caregivers. Willing to pay method Was used to estimate the intangible costs.Multiple linear stepwise regression models were conducted to determine the factors linked to the economic burden. We constructed a decision tree model to evaluate the hepatitis B vaccination strategies for the people of 1 to 14 years old and a Markov model of disease progression to evaluate the economic impacts accruing from treated and untreated chronic HBV infection. The parameters of HBVM positive rate and positive rate anti-HBs after vaccination were to get through the Meta analysis. The cost variables for HBV–infected were to obtain from the investigation of the economic burden of hepatitis B-related diseases. Other parameters were based on data published by the peer-reviewed Chinese and English publications, and were derived from expert's assessment and evaluation.We used cost-benefit analysis to select the best hepatitis B vaccination strategy for different groups of population.We adopted sensitivity analysis and threshold analysis to explore the main influencing factors on the best vaccination strategy.ResultsOn average, the total annual cost of per-patient with hepatitis B-related diseases was 102454.9 Yuan (RMB), among which, direct, indirect and intangible costs were 39403.7 Yuan, 8730.7 Yuan, 54320.4 Yuan, respectively. The total annual costs per-patient for Liver Transplantation, severe hepatitis B, hepatocellular carcinoma, cirrhosis, chronic hepatitis B and acute hepatitis B were 206161.5 Yuan, 143755.4 Yuan, 125911.1 Yuan, 124520.0 Yuan, 72360.4Yuan and 45103.6 Yuan, respectively. The ratio of direct to indirect costs based on the base-case estimation foot add to 4.5:1. Direct medical costs were more than directnonmedical. The proportions of total annual cost per patient with hepatitis B-related diseases accounted for annual patient income were 495.3%, and 75.4%for annual household income. The response rate of the approach combined open-ended questions with iterative bidding game was the highest (76.6%) among the three WTP elicitation formats. The optimizing immunization strategy for each age group of 1-14 years was inoculating three 10μg vaccines after screening the markers anti-HBs and HBsAg, the NB of which in population of different age were 61345.42 Yuan (in Renminbi), 2821.00 Yuan, 2731.66 Yuan, and the BCR were 5.75, 4.03 and 3.74 respectively. The order of the sensitivity of the different parameters involved in the model: HBVM positive rate, the coverage of hepatitis B vaccine, discount rate, positive rate anti-HBs after vaccination, the costs of HBV-infected, screening fees and vaccines and vaccination fees.ConclusionThe economic burden of hepatitis B-related diseases was substantial for patients and their families. The direct, indirect and total cost tended to increase with the severity of disease, but the intangible cost not so. The direct costs were larger than the indirect costs, and the direct medical costs were more than the direct ones. The approach of combined open-ended questions with iterative bidding game should be recommended in further WTP studies.The decision tree model of hepatitis B vaccination strategies and the Markov model of disease progression for population of 1 to 14 years old had good applicability to evaluate the hepatitis B vaccination strategies. At the present stage, inoculate three 10μg vaccines after screening the markers anti-HBs and HBsAg was the optimizing immunization strategy for each age group of 1-14 years.And the younger should be inoculated first.
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