Cost-effectiveness And Affordability Of Current Strategies For Hepatitis B Vaccination In China

Objective:Currently, the government of China incorporated a nationwide prevention of mother-to-child transmission(PMTCT) programme for hepatitis B into existing neonatal hepatitis B vaccination strategy. Cost-effectiveness analysis is very important for clearing the economic efficiency of PMTCT strategy at present stage. Our research aimed to construct decision-analytic markov model for hepatitis B vaccination strategies in China, and evaluate the cost, effectiveness, and economic values through a cost-effectiveness analysis from the society and payer’s viewpoint respectively. Basing on these, cost-effectiveness affordability curves were brought in to estimate the budget impact on the vaccination program, which could provide a scientific basis for better implementation of the strategy. Methods:According to the decision analysis and expected utility theory and method, we integrated parameters quantitatively and developed a decision-analytic markov model drawing on Chinese vaccination history, which used the PMTCT strategy to neonatal hepatitis B vaccination strategy and vaccination strategy as the control strategy respectively. Parameters in model, including prevalence of HBsAg positive carrier mothers, hepatitis B vaccine coverage, vaccine efficacy, and so on, were obtained from national epidemiological investigations and meta-analysis. We used a Chinese birth cohort in 2013 to simulate the clinical and economic outcomes for different vaccination strategies by TreeAge software 2015. Calculating the cost only consider the Hepatitis b immune prevention costs from the payers’ view or including the direct and indirect costs from the societal perspective at the same time. Effectiveness estimation, including No. of HBV infections averted, life years extended and QALYs gained. Therefore, we used incremental cost effectiveness ratio(ICER) as an indicator to evaluate the cost-effectiveness of the strategies above. With one-way, multi-way and probability sensitivity analysis, the confidence of results was validated. In addition, considering the cost-effectiveness and financial budget for current PMTCT strategy, affordability curve and cost-effectiveness affordability curves were introduced to estimate the budget impact on the vaccination program. Results:We designed a decision analytic model for three vaccination strategies, which including three different branches following multi stage opportunity node. In the end of all the paths, it would come to three types of outcome, including immunity, infection and susceptible connecting to the Markov model respectively.. A total of 34 items of 8 categories parameters were also fit into the model, excluding the disease transition probabilities in Markov model.Comparing to the no vaccination strategies from societal perspective, hepatitis B PMTCT strategy implementing in 2013 birth cohort would have avoided 10.143 million cases of HBV infection, which including 0.904 million cases of acute hepatitis B and 2.121 million cases of chronic hepatitis B. Within chronic hepatitis B, there were 1.003 million cases of cirrhosis and 0.636 million cases of Hepatocellular carcinoma. A total of 1.501 million people would have avoided dying from hepatitis B related disease. In addition, hepatitis B PMTCT strategy would have saved 37829.7 RMB, and extended 0.5362 life years, or gained 0.6397 QALYs for each people. Comparing to no intervention, hepatitis B PMTCT strategy would have saved 70551.5 RMB per additional life years extended or gained 59136.6 RMB per additional QALYs, which could be a cost-saving. Event thought compared with neonatal hepatitis B vaccination strategy, PMTCT strategy would have avoided 46000 more cases of HBV infection, save 70551.5 RMB and extended 0.0040 more life years, or even gained 0.0049 more QALYs. It’s was estimated to save 59950 RMB per additional life years extended or 48938.8 RMB per additional QALYs gained, and was found to be cost-saving. One way sensitivity analysis showed that the HBsAg positive rate of pregnant women and the cost of vaccine were the most sensitive parameters in the comparison of PMTCT strategy and no intervention. In the meanwhile, HBsAg screening fees and HBIG vaccination coverage were the most sensitive in the comparison of PMTCT strategy and neonatal hepatitis B vaccination strategy. The results of both multi-way and probabilistic sensitivity analysis have showed that the conclusions obtained from the baseline study were reliable.From the payer’s perspective, PMTCT strategy would gain 0.0049 more QALYs, but cost 16.2 RMB, estimated to cost 3306.1 RMB per additional QALYs gained, less than per capita GDP(43300 RMB), it was found to be cost-effective. The cost-effectiveness affordability curve showed that the cost-effectiveness acceptability and affordability of Hepatitis B PMTCT strategy will reach 100%, along with budget of 328 million yuan and willingness-to-pay of 17000 yuan/QALY. It indicated that Hepatitis B PMTCT strategy was affordable from either payer’s or societal perspective in current economic conditions. Conclusion: 1. Our decision-analytic markov model was feasible and effective in cost-effectiveness analysis in hepatitis B vaccination strategies in China. 2. Hepatitis B PMTCT strategy would have saved 37829.7 RMB and estimated to have saved 59136.6 RMB while per additional QALYs gained. It was a cost-saving strategy comparing to no intervention. 3. Compared with neonatal hepatitis B vaccination strategy, PMTCT strategy would have saved 239.8 RMB and estimated to have saved 48938.8 RMB while per additional QALYs gained. Even though PMTCT strategy had higher cost relatively, it was also found to be cost-saving. 4. HBsAg positive rate of pregnant women and the cost of vaccine, HBsAg screening fees and HBIG vaccination coverage were the most sensitive parameters in the comparisons of PMTCT strategy and no intervention, and comparisons between PMTCT strategy and neonatal hepatitis B vaccination strategy. The results of both multi-way and probabilistic sensitivity analysis have showed that the conclusions obtained from the baseline study were reliable. 5. The cost-effectiveness acceptability and affordability of Hepatitis B PMTCT strategy will reach 100%, with budget of 328 million yuan and willingness-to-pay of 17000 yuan/QALY. It’s indicated that Hepatitis B PMTCT strategy was affordable from either payer’s or societal perspective in current economic conditions, and should be promoted.