| objective China has promoted the application of hepatitis B vaccine for more than 10 years in newborns. Significant changes have taken place in the mode of hepatitis B virus infection in general population, therefore, there is an urge to conduct tracking decision analysis for hepatitis B vaccination strategy. In recent years, the effect of hepatitis B vaccination including immunology effect, epidemiology effect and health economics effect were assessed throughout the country, and a great deal of information has been accumulated through epidemiological investigations, however, there is no academic reports on medical economics evaluation of the effect of hepatitis B vaccination and tracking decision analysis for hepatitis B vaccination strategy. In this paper, we constructed decision tree model by referring to domestic related important study results on hepatitis B in order to analyze the economic effectiveness of the 14 years long hepatitis B vaccination strategy implementation, and selected the best hepatitis B vaccination strategy for different groups of people. The study results can provide relevant departments with statistical basis for hepatitis B vaccination strategy making.Methods To construct effect evaluation decision tree model for 14-year-long China hepatitis B vaccine immunoprophylaxis and multi-level decision tree model for hepatitis B vaccination strategy in newborns on the basis of integrating relevant information and a full consideration of the influence of the HBV infection rate, the vaccination rate, the protection rate, various kinds of turnover probability after HBV infection, the new HBV infection rate of the susceptible population in one year, treatment charges for HBV infection, vaccines and vaccination fees, screening fees, the discount rate, and the newborns population born in one year, access the economic effect of 14 years long neonatal hepatitis B vaccination strategies implementation with cost-benefit and cost-effect annalysis indexes and optmize the best strategy for hepatitis B vaccination in different groups of people; to explore different fators' influnence on the models by applying sensitive analysis; Epidata3.1 and Excel were applied to analyze the datas.Results 1. Almost 65 229 476 cases (24 423 516 cases in urban area, 408 05 960 cases in rural area) with hepatitis B virus infection, included 13 045 894 acute patients, 652 294 chronic patients, 60 076 cases with cirrhosis and 6 007 with hepatoma, had been prevented because of the hepatitis B vaccination among the infants during 1992 through 2005 in China. The BCR was 51.01:1 (49.59:1 in urban area, 51.91:1 in rural area). The order of the sensitivity of the different parameters involved in the model: treatment charges for HBV infection, whole range vaccination rate, the vaccine protection rate, the newborn Infants population born in one year, the new HBV infection rate of the susceptible population in one year, vaccines and vaccination fees. 2. The first immunization Method among the infants had the least CER (169.11) and the maximum BCR (19.14:1). compared with no vaccination, the CER of immediate vaccination and vaccination after screening in population of different age were 603.91, 497.35, 577.60, 987.40, 1 269.34, 1 692.46, 1 870.99, 2 090.80 and 491.47,444.53,487.38,637.58,718.09,838.97,890.06,952.81,and the BCR were 5.36,6.51,5.60,3.28,2.55,1.91,1.73,1.55 and 6.59,7.28,6.64,5.08,4.51,3.86,3.64,3.40 respectively. So the revaccination programme after screening is better than direct inoculation programme, and its effectiveness in the younger is better than in the older. After increases in immunization in different age groups of population, optimized vaccination programme is still the revaccination programme after screening. Under the current hepatitis B vaccination, for the people of 1 to 14 years old protective antibody anti-HBs and HBVM the total positive rate less than 53 percent, optimized programme is direct inoculation and when more than 53 percent, that is the revaccination programme after screening. For the people of greater than or equal 15 years old, protective antibody anti-HBs and HBVM total the positive rate less than 30 percent, optimized programme is direct inoculation and when more than 30 percent, that becomes the revaccination programme after screening. The order of the sensitivity of the different parameters involved in the model: protective antibody anti-HBs positive rate, treatment charges for HBV infection, the vaccine protection rate, the new HBV infection rate of the susceptible population in one year, screening fees, HBVM cumulative positive rate, vaccines and vaccination fees, The discount rate.Conclusion 1.The China 14-year-long strategy of hepatitis B vaccination performed among the newborns had obtained significant economic results. Decision tree was one of the most useful models to analyze the effectiveness of hepatitis B vaccination. 2.The optimizing immunization strategy was direct inoculation among the newborn infants. In other population, the revaccination after screening was optimizing strategy, and the younger should be inoculated first. |
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