| OBJECTIVE: The decision analytic-Markov model was applied to forecast the investment,benefit and effectiveness of the hepatitis B immunization program in China and in Shenzhen during 2006-2015 and 2016-2030.The objective of our study was to verify the economic value of this strategy and explore the characteristics of the economic effectiveness of hepatitis B immunization of Shenzhen,which is able to provide evidence to support sustained hepatitis B immunization,so as to promote our country to achieve the goal of eliminating hepatitis B by 2030.The evaluation of substantial reductions in benefit and effectiveness caused by Adverse Events Following Immunization(AEFIs)in China in 2013 may clarify the impact of the negative factors on benefit and effectiveness.In addition,the applicability of the decision analytic-Markov model in predicting the outcomes of hepatitis B immunization was discussed.METHODS: Based on the actual situation of hepatitis B immunization,a decision analytic-Markov model was applied to the data from China and Shenzhen.The model was described the actuality of the universal hepatitis B vaccination and prevention of mother-to-child transmission strategy through setting the vaccine immunization rate and cost parameters.The birth cohort of 2006-2030 was set up as the study population.The impact of the vaccination program was evaluated over a broad period: the past immunization period 2006-2015 and the future period 2016-2030.Using the model,we evaluated the influence of AEFIs on the cost,benefit and effectiveness of hepatitis B in China and Shenzhen.The analysis was performed from societal,health care,and payer's perspectives.For the societal perspective,we included direct medical costs(immunization cost and the averted costs of treatment for HBV infections),direct nonmedical costs and indirect costs.For the health care perspective,only direct medical costs were included.For the payer's perspective,we included only the immunization cost.The effectiveness was measured in quality-adjusted life years(QALYs),life years(LYs)and the number of HBV infections and hepatitis B related diseases.The QALYs and LYs gained were calculated at a 3% discount rate.The benefits of hepatitis B immunization consisted of the savings from reduced numbers of HBV infection and hepatitis B-related diseases resulting from immunization strategy,including direct medical and nonmedical and in-direct cost.The net present value(NPV)is the sum of the discounted benefits from the immunization program minus the sum of the discounted costs.The benefit cost ratio(BCR)is equal to the discounted costs averted by the immunization program divided by the discounted immunization program costs.The models operated and the costs,benefits and effectiveness calculated were implemented using Tree Age Pro 2016 as software program.RESULTS: The analyses showed that the hepatitis B vaccination immunization among members of the 2006-2015 birth cohort would prevent 97.67 million cases of HBV infection,saving 77 million LYs and 96 million QALYs in China.For the payer's perspective,total costs were 43.97 billion yuan during the period 2006-2015 in the immunization scenario.For the immunization strategy,the health care and societal NPVs were 4.35 trillion yuan and 5.37 trillion yuan and the BCR was 7.96 and 7.61,respectively.The immunization program could prevent 172 million cases of HBV infection and add 110 million LYs and 137 million QALYs in the future.Total costs during the period 2016-2030 according to the payer's perspective in the immunization scenario would be 10.44 billion yuan;for the immunization strategy,the health care and societal NPVs would be 7.27 trillion yuan and 8.98 trillion yuan and the BCR would be 10.70 and 9.73,respectively.In Shenzhen,the hepatitis B immunization program among children born between 2006 and 2015 could prevent 605847 HBV infections and saved 0.35 million LYs and 0.43 million QALYs.According to the model,the immunization of 10 infant cohorts during the period 2006-2015 cost 33 million yuan in the pay's perspective.The health care and societal NPVs for immunization program in Shenzhen was 22.37 billion yuan and 37.98billion yuan and the BCRs were 14.62 and 13.20,respectively.The immunization among members of the 2016-2030 Shenzhen birth cohort will prevent 1.87 million cases of HBV infection,with saving 0.98 million LYs and 1.18 million QALYs.Total costs during the period 2016-2030 according to the payer's perspective in the immunization scenario would be 120 million yuan;for the immunization strategy,the health care and societal NPVs would be 66.31 million yuan and 112.15 billion yuan and the BCR would be 18.12 and 15.36,respectively.An excess of 2.13 million HBV infections and a loss of 1.51 million LYs and 1.96 million QALYs were estimated to occur in the 2013 birth cohort due to the AEFIs.Health care and societal benefits loss due to the AEFIs was an estimated 111.49 billion yuan and 139.12 billion yuan,respectively.Because of the AEFIs,our model estimated there 18.1 thousands cases of HBV infections would be added and 10166.59 LYs and 12330.57 QALYs would be lost among 2013 birth cohort in Shenzhen.Meanwhile the benefits of immunization there were 714 million yuan reduced from health care perspective and 1.22 billion yuan be lost from societal perspective.With the basic parameters remaining constant,the yearly variations of vaccination rates,costs and the number of births were introduced to a decision analytic-Markov model.An a posteriori analysis evaluated the cost,benefit and effectiveness that the hepatitis B immunization program had up to the present day.Future benefits,costs and effectiveness were also forecast by the model.CONCLUSIONS: 1.During the past 10 years,hepatitis B immunization of infants has been provided free of charge nationally.The hepatitis B immunization strategy was not only to avoid a lot of HBV infections and hepatitis B related disease,but also to prolong the life and improve the quality of life.The hepatitis B immunization program has more net benefits and the main benefits was due to avoided treatment of chronic hepatitis B cases and of cirrhosis cases.The economic benefits of this program were relatively significant.In the next 15 years,the implementation of the hepatitis B immunization program still required more investment,but the further benefits and effectiveness would be increasingly evident in the future.2.The immunization program in Shenzhen dominated over the immunization program in the whole country.It mainly reflects in four aspects: lower infection rate,less cost,more effectiveness and higher BCR.This is consistent with the epidemiological results ofhepatitis B,indicating that it is still economical to further implementation of hepatitis B immunization.3.This analysis shows that serious economic consequences will be caused by the AEFIs,so that the cost increased,the benefit and effectiveness reduced significantly.Additionally,good hepatitis B immune system has a better ability to resist,the AEFIs on the impact of Shenzhen was significantly lower than the national.4.A decision analytic-Markov model can be used to evaluate and to forecast the cost,benefit and effectiveness of hepatitis B immunization.This paper calculates the effect of birth cohort and the cumulative effect of age groups,so as to know the recent and long-term effects of hepatitis B related diseases. |
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