| Objective Post-vaccine serologic testing(PVST)can strengthen the standardized management of chronic hepatitis B infected pregnant women and their babies,early detection of immune unresponsive infants and timely strengthening of immunization,which play a crucial role in futher preventing mother-to-child transmission of hepatitis B.In this study,based on the preliminary estimation of the operating cost of PVST for infants born to HBsAg-positive mothers in Zhejiang Province,a decision tree-Markov model was constructed to evaluate the health economic value of PVST strategy,and to provide a scientific basis for further eliminating mother-to-child transmission of hepatitis B in China.Methods Field investigations were carried out in 3 PVST pilot districts and counties in Zhejiang Province.Through face-to-face interviews and questionnaires,the work flow and work costs of the main operating institutions of PVST(local centers for disease control and prevention,community health service centers and hospitals)were obtained.We estimated costs using four methods:auditing,a time driven activity-based costing approach,estimation by experts,and the human capital method.Based on the cost data,the monitoring data of the information system of the Zhejiang Provincial Center for Disease Control and Prevention and the literature search,a decision tree-Markov model was constructed.In the model,we ran a 1year cycle length with an 81 horizon(life expectancy in Zhejiang Province,2020)to simulate the lifetime effect of disease progression in target population.The health economics value of PVST was evaluated from the perspectives of health care,payers and the whole society,and the results are summarized from the perspectives of cost-benefit(BCR),incremental costeffectiveness(ICER)and incremental cost-utility(ICUR).One-way sensitivity analysis(OWSA)and probabilistic sensitivity analysis(PSA)were performed to explore the effect of parameter uncertainty in the model.Results The cost survey conducted by the main participating institutions(local centers for disease control and prevention,hospitals and community health service centers)in the pilot counties and districts of Zhejiang Province(Jinyun,Suichang,Jiaojiang)showed that the cost of current strategy is 301.99 yuan/person,the cost of PVST testing is 492.6 yuan/person,and the cost of re-vaccination based on PVST results is 665.6yuan/person.The Markov model simulation results show that the strategy of preventing mother-to-child transmission of hepatitis B through PVST in Zhejiang Province requires a total cost of 112 million yuan,which can save 20 million yuan compared with the current strategy.The cost-benefit analyses showed that the benefit of the PVST strategy was 111.34 yuan,and the BCR was 0.05;the cost-effectiveness analyses showed that the implementation of the PVST strategy could avoid a total of 204 cases of hepatitis B-related diseases and 69 cases of hepatitis B-related deaths,that is,under the PVST strategy,the prevention of 1 hepatitis B-related diseases(ICER1)can save 98,473.47 yuan,and the prevention of 1 hepatitis B-related death(ICER2)can save 291,138.96 yuan;cost-utility analyses shows that PVST can reduce the cost of 401.77 yuan compared with current strategy,while obtaining 0.03QALYs,the ICUR is-14752.05 yuan/QALY.Conclusion The cost of carrying out PVST in Zhejiang Province is much lower than the medical burden caused by hepatitis B,and the government bears the main expenses,which has high operability in Zhejiang Province.The results of health economics evaluation show that compared with current strategy,PVST can further improve the effect of mother-to-child blocking of hepatitis B,reduce hepatitis B-related morbidity,and obtain more QALYs while reducing the total cost.The value of health economics is obvious.PVST strategy has strong feasibility and good effect,and it is necessary to further promote the PVST in the whole province of Zhejiang Province. |
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