| Hepatitis B virus (HBV) infection continues to be a serious health threat to the population in China. The national strategy for prevention and control for HBV transmission has largely focused on vaccination. And the effect has been recognized. Among which, the priority group of hepatitis B immunization is newborns. The Chinese government has implemented the programs of providing nationwide free HBV vaccines for all newborns and officially adding infant HBV vaccination to China's National Immunization Program for more than 10 years. The programs has consistently improved the crowd HB infection model in the population. However, the optimal newborn immunization program according to the current situation and the factors which affected the optimization program are remain unclear. Therefore, in the current study, the decision science and heath economics method were adopted to evaluate the optimal vaccination model and cost-benefit for the HBV immunization strategy in the newborns in China.ObjectiveThe purpose of this study is to construct multistage decision trees and Markov model according to the actual newborn vaccination in China. By using decision analysis and cost-benefit analysis method, total costs, net present values (NPVs), and benefit-cost ratios (BCR) were evaluated and the optimal newborn vaccination programs were developed. According to the cost of HBV infection, which is the most critical parameter, this study mainly introduces the economic burden of hepatitis B-related diseases and main factors associated with the costs in Shenzhen.MethodsTreeAge Pro Software 2009 decision analysis was used to build multistage decision tree and Markov model. Markov model was used for HBV infection and progression. Meta-analysis was used to synthesize effect size of individual domestic and foreign relevant research result. Total cost, benefit, NPVs and BCR were calculated by TreeAge software. Sensitivity analysis was used to analyze the impact of the parameters in the optimal program. The direct, indirect and intangible costs due to hepatitis B-related diseases were investigated. Direct costs included direct medical and direct nonmedical costs. Human Capital Approach was employed to measure the indirect costs both on patients and the caregivers in 1-year time span. Per capita wage for the working population and the current market price of housekeeping activities for the non-working, per capita disposable income, per capita gross domestic product (GDP) and human capital method combined with DALYs methods were used to evaluate and explore the indirect costs. Willing to pay method was used to estimate the intangible costs. Non-parametric test and multiple linear stepwise regression models were fitted to identify the factors linked to the costs.Results1. The optimal newborn immunization program:By the analysis of the decision tree and Markov model conducted according to the actual conditions, the current optimal newborn immunization was that all the newborns were injected three shots 10μg hepatitis B vaccine directly without screening the pregnant women. The BCRs of different vaccination programs were all more than one. Therefore, it could choose the appropriate vaccination program according to the actual situation. By univariate sensitivity analysis, the sentitive factors were vaccine protection rate, the costs of HBV infection, vaccination fees, inoculation rate, maternal HBsAg positive rate, and screening fee. For the optimal program, the sensitivity parameters were vaccine protection rate, vaccine inoculation rate, the costs of HBV infection, discount rate, HBV infection rate, and vaccination fee.2. Analysis on the economic burden of hepatitis B-related diseases in Shenzhen: Among the 654 subjects who had completed the investigation, there were 519 male (79.4%) and 135 female cases (20.6%). Average age was 37.637.6±12.8 years old, males were 38.0±12.2 years old and females were 36.2±14.8 years old. On average, the total annual cost of per patient with hepatitis B-related disease was 88485.00 Yuan, among which, direct cost was 30914.79 Yuan (34.9%), indirect cost was 22152.78 Yuan (25.0%) and intangible cost was 35417.43 Yuan (40.0%). The total ratio of direct to indirect cost was 1.4:1. Among which, compensated cirrhosis was the highest (4.5:1), hepatocellular was the lowest (0.3:1). The direct medical costs were higher than that of the direct nonmedical (the ratio was 16.1:1). The indirect costs estimated by human capital method combined with DALYs was the highest (164942.70 Yuan). Estimated by per capita GDP, per capita wage for the working population and the current market price of housekeeping activities for the non-working and per capita disposable income were 54631.22 Yuan,22152.78 Yuan and 17221.87 Yuan respectively. By univariate analysis, gender, medicare and employment situation were common determinant factors for direct, indirect and total cost. Gender, medicare and education level were significant influencing factors for intangible cost. Based on multiple linear stepwise regression analysis, common influencing factor for all kinds of costs was age.Conclusions1. At present, the optimal newborn vaccination is that all the newborns are injected three shots 10μg hepatitis B vaccine without screening the pregnant women.2. The decision tree and Markov model has good applicability and reliability for quantitative optimization of newborn vaccination program.3. The economic burden of hepatitis B-related diseases used in the model and the parameters obtained by meta-analysis have certain authority. Other parameters had also paid attention to the evidence, in order to improve the validity of the model operation result.4. For the optimal program, the sensitivity parameters are vaccine protection rate, vaccine inoculation rate, HBV infection fee, discount rate, HBV infection rate and vaccination fee.5. Hepatitis B-related patients bear a heavy economic burden. The financial burden tends to be increased with the progress of the disease.6. The indirect costs evalued by per capita wage for the working population and the current market price of housekeeping activities for the non-working and per capita disposable income are moderate. These methods are suitalbe for economic burden of hepatitis B-related diseases study. |
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