Economic Evaluation Of Preventing For Mother-to-child Transmission Of Hepatitis B Virus And Prophylactic Entecavir Use For Community-based Population In Shenzhen

ObjectiveThe purpose of this paper was to construct a decision analytic-Markov model to estimate the benefits and efficiencies of strategy for preventing mother-to-child transmission(PMTCT) of hepatitis B virus(HBV) based on both cost-benefit analysis(CBA) and cost-effectiveness analysis(CEA). In addition, the study wanted to answer wheather prophylactic entecavir use for treating chronic hepatitis B(CHB) patients among community-based population would be cost-effective in Shenzhen. In the process, the differences of applicable conditions between CBA and CEA and their roles in the quantitative optimization were explored.Subjects and methodsAccording to the principles of decision analysis and Markov processes, the PMTCT was determined as an evaluated strategy compared with the universal vaccination and no intervention respectively. Related parameters of Shenzhen were introduced to the model, and a birth cohort of 2013 was set up as the study population.Net present value(NPV), benefit-cost ratio(BCR) and incremental cost-effectiveness ratio(ICER) were calculated. Univariate sensitivity and multivariate sensitivity analyses were conducted to verify the impact of parameter uncertainty.In the decision analytic-Markov model of antiviral treatment, no treatment was designed as a comparison, and a cohort of one hundred thousand people was set up as the study population. The cost, QALY and ICER were calculated, and the cost-effectiveness of antiviral treatment was estimated by ICER in comparison with per capital gross domestic product(GDP) of Shenzhen. Besides univariate sensitivity and multivariate sensitivity analyses, affordability analysis was conducted to estimate the budget impact on antiviral treatment.ResultsIn the decision-analytic Markov model of hepatitis B immunization, three decision branches were included, and probability nodes covered HBs Ag screening rate, the positive rate of pregnant women, the vaccine and HBIG coverage rate, etc.Three kinds of Markov models were used to simulate outcomes after vaccination.There were four kinds of parameters in the model, including rates, costs, utility values and transmission probabilities. The BCR of PMTCT was 16.22 from health care perspective and 14.37 from societal perspective, both higher than universal vaccination(13.42 and 12.07, respectively). For the birth cohort of Shenzhen in 2013,the social resource of input was 170 million yuan and output was 2.437 billion yuan,with NPV as 2.267 billion yuan. Compared with universal vaccination, the ICER of PMTCT were 1747.46 yuan per QALY gained from payer’s perspective,-51775.93 yuan per QALY gained from health care perspective, and-85100.00 yuan per QALY gained from societal perspective, all of which indicated that PMTCT was highly cost-effective. Sensitivity analyses indicated the results of CBA and CEA were stable and were sensitive to vaccination coverage rate and costs of hepatitis B related diseases. Affordability analysis showed that PMTCT strategy would be 100%affordable when the budget reached 2.30 million yuan, with a 0.96 million yuan higher than universal vaccination.There were two decision branches in the decision-analytic Markov model of antiviral treatment, and probability nodes covered HBs Ag screening rate, the HBs Ag positive rate in adults, the rate to visit specialists, the rate of active chronic infection,and the incidence of adverse invents. Also four kinds of parameters were used in the model, including HBs Ag positive rate and the rate of active chronic infection, costs,rates of compliance, and transmission probabilities. Compared with no treatment, the ICER of antiviral treatment was 87003.63 yuan per QALY gained from payer’s perspective and 11938.74 yuan per QALY gained from societal perspective(both less than GDP per capital of Shenzhen), which meant the strategy was highly cost-effective. The ICER increased with age, and there were the lowest ICER in 20~29 group with 65741.63 yuan per QALY gained from payer’s perspective and-1592.34 yuan per QALY gained from societal perspective. Univariate sensitivity analysis showed that ICER was most sensitive to cost of enticavir and costs of hepatitis B related diseases, and affordability analysis indicated that antiviral treatment would always implementable when the budget exceeded 752 million yuan for one hundred thousand people.Conclusion1. The strategy for PMTCT gained more monetary benefits(14.37:1) than universal vaccination(12.07:1).2. The strategy for PMTCT further reduced the occurrence of hepatitis B related diseases and increased life years; compared with universal immunization, the strategy for PMTCT cost more but it was highly cost-effective.3. The fluctuant of parameters in the model didn’t change the basic results.Hepatitis B vaccination rate and costs of hepatitis B related diseases were the most important parameters influence CBA and CEA results.4. The budget and willingness-to-pay for the strategy of PMTCT were within payer’s affordability, which meant PMTCT was affordable.5. The ICER increased with age at antiviral treatment, but it was still cost-effective for all age group.6. There were high budget and willingness-to-pay for antiviral treatment; the results were most sensitive to cost of enticavir.7. CBA seemed suitable for strategy optimization while CEA was better for strategy evaluation. The combination of the two methods would facilitate the process of economic evaluation. When used in CEA, the affordability analysis could assist decision makers in proper health investments.