Disease Burden Of Hepatitis E And Health Economic Evaluation Of Vaccine-immunization Strategies

Background and objective:Hepatitis A and hepatitis E are two kinds of enterically-transmitted hepatitis, and hepatitis E takes higher proportion of acute viral hepatitis while hepatitis A is well controlled by vaccine-immunization. To date, one hepatitis E vaccine has been allowed for use in Chinese adults, but recommendation concerning vaccination strategies urgently need to explore. In this study, survey regarding disease burden of hepatitis E is conducted to provide data for building health economic models of immunization strategies. Then, the economic impact of hepatitis E vaccination strategies (vaccinating all members, screening and vaccinating IgG negative members, and not vaccinating) in general or olderly population living in hepatitis E sporadic region, and pregnant population living in hepatitis E outbreak area are evaluate, which might provide the reference for dominate hepatitis E vaccine-immunization strategy in developing countries.Methods:Disease burden survey including direct cost, indirect cost, intangible cost and quality of life was undertaken by designed questionnaire and hospital-based administration system in Jiangsu province, hepatitis E cases which reported between 2008 and 2015 in suspected viral hepatitis active surveillance network were recruited. According to survey, published articles and experts'opinion, decision tree-Markov model were constructed in a cohort from general or olderly population to compare the incremental cost effectiveness ratio or incremental cost utility ratio from 3 scenarios:vaccination, screening and vaccination, and no vaccination. Besides, decision tree model was constructed in a cohort from pregnant population to compare the incremental cost utility ratio from above 3 scenarios before conception. Moreover, one-way, two-way, three-way and probabilistic sensitivity analysis were used to evaluate the uncertainties of models.Results:(1) The median economic burden of 489 hepatitis E cases was 11438.39, which was accounted for 51.23% of residents'disposable income. The median economic burden of outpatients and inpatients were 722.19,20380.08, respectively. The median value of EQ-5D utility of 489 cases were 0.71QALY, and the median QALY of outpatients and inpatients were 0.77,0.66, respectively. Hepatitis E related cost of male was significantly higher than female, and EQ-5D utility of male were significantly lower than female; moreover, cost of HEV-HBV coninfected inpatients was higher than others. (2) From the societal perspective, to general population, compared with not vaccinating, ICER of vaccinating all, screening and vaccinating were 326598.33/symptomatic case (>WTP threshold),156769.60/symptomatic case (>WTP threshold), respectively, ICUR of vaccinating all, screening and vaccinating were 133451.82/QALY(<WTP threshold),65258.89/QALY(<WTP threshold), respectively. Moreover, the strategy of screening and vaccination had lower cost and higher QALY than the strategy of all vaccination. Sensitivity analysis observed price and efficacy of HE vaccine, decline rate of vaccine efficacy, and QALY of asymptomatic case were important factors of immunization strategies. To the olderly population, compared with not vaccinating, ICER of vaccinating all, screening and vaccinating were 143536.27/symptomatic case(<WTP threshold), 67153.08/symptomatic case (<WTP threshold), respectively, ICUR of vaccinating all, screening and vaccinating were 57358.13/QALY(<WTP threshold),27368.45/QALY(<WTP threshold), respectively. Moreover, the strategy of screening and vaccination had lower cost and higher QALY than the strategy of all vaccination. Sensitivity analysis observed efficacy of HE vaccine, decline rate of vaccine efficacy, and QALY of asymptomatic case were important factors of immunization strategies. (3) From the societal perspective, compared with not vaccinating, ICER of pregnant women received vaccination before conception, screening and vaccination before conception were 3305.15/QALY(<WTP threshold),1217.82/QALY(<WTP threshold), respectively. Moreover, the strategy of screening and vaccination had lower cost and higher QALY than the strategy of all vaccination. Sensitivity analysis observed price of HE vaccine and level of natural immunity were important factors of immunization strategies.Conclusion:(1) Hepatitis E have brought economic and health burden to society and family. (2) From the societal perspective, there is not a consistent opinion to the dominate hepatitis E vaccine-immunization strategy to general population based on ICER and ICUR. Vaccination is the dominate strategy to the old living in hepatitis E sporadic region, and efficacy of HE vaccine, QALY of asymptomatic case are important factors to dominate immunization strategy. (3) From the societal perspective, screening and vaccination is dominate strategy to pregnant women living in outbreak area, price of HE vaccine and level of natural immunity are important factors to influence whether screening or not is dominate immunization strategy.