| ObjectiveThis research conducted cost-utility analysis to evaluate the universal hepatitis B(HB)vaccine immunization program from 1992 to 2013 in Beijing,aiming to provide reliable data evidence for decision-maker on improving universal hepatitis B vaccination program.The specific objectives are listed as follows:(1)This research employed the data from Beijing medical price platform,annual work report of Beijing CDC,China health statistics yearbook and National Health Service Survey report.Newborn cohort,natural mortality rate,HBV prevalence rate and life expectancy were extracted from health statistical yearbook of Beijing,data of 1%population sampling survey in Beijing and sero-epidemiological survey report of viral hepatitis in Beijing.Transmitted probability and utility scores of HBV diseases were from public literature.(2)Discount method in costThe direct treatment cost of HBV related diseases from 1992 to 2012 were adjusted to 2013 price level by using GDP deflator to compare the cost among different years on the same price level.(3)Selecting newborn cohort born in 1992,2002 and 2013 as target population and constructing Decision-Markov model to conduct cost-utility analysis evaluating the effect of newborn HBV vaccine immunization policy in a long-period.Parameters uncertainty was tested by one-way and multi-way sensitivity analysis.Methods(1)Literature investigationDirect in/out patient treatment cost of HB-related diseases,per capital medical expenses of Beijing residents and average annual visit times were extracted from Beijing Health and Medical Price Monitoring Data Platform,China statistical yearbook and national health report respectively.Demography data such as newborn cohort,life expectancy,HBsAg positive rate were extracted from annual work report on Beijing CDC,Beijing health statistical yearbook sero-epidemical investigation of virtual hepatitis respectively.Transition probability and utility scores of HB-related diseases were extracted from public literatures in Beijing.(2)Multi-steps model methodEvaluating the direct treatment cost of hepatitis B related diseases in 2016 according to information of patients who had been accepted treatment in tertiary and secondary hospitals.HB-related single disease direct treatment cost from 1992 to 2013 were calculated through several steps,by adding up average annual direct medical cost of outpatients and inpatients.Average annual direct medical cost of outpatients and inpatients were deduced by multiplying average annual medical cost and average visit times.(3)Missing value fillingThe missing value in age difference HBsAg positive rate,yearly hospital visit times and annual average direct treatment cost of hepatitis B related diseases from 1992 to 2013 in Beijing were filled by using average speed of growth.(4)Cost discountWhen analyzing the average annual direct medical cost of HB-related diseases among separate years,the cost from 1992 to 2012 were adjust to 2013 price level by using GDP deflator.(5)Cost-utility analysisA decision-Markov model was constructed to determine the cost-utility of the universal immunization strategy in 1992,2002 and 2013,and made further comparison of results in these three years which represented the period of beginning,pre and post adjustment of immunization charge.Results(1)A birth dose of hepatitis B vaccination rate was increased from 85.92%to 99.95%,and almost all of newborns have been vaccinated.HBsAg positive rate decreased at all ages from 1992 to 2013,especially among children under 5 years old which was dropped to 0.00%since 2006.(2)Direct treatment cost of HB related diseasesAverage annual direct treatment cost of HB related diseases from 1992 to 2012 was adjusted to the price level by GDP deflator,which was volatility raised from 1992 to 2013,and reached a highest value in 2013.The proportion of inpatient direct treatment cost of HB related diseases was at the range of 87.30%to 98.44%,in which hepatocellular carcinoma and cirrhosis accounted for a large proportion that reached the peak at 2009 respectively.For the part of outpatient,medical treatment cost of chronic hepatitis B was the highest among 5 diseases which was 1,692.47 yuan reach the peak in 2009.And the second was hepatocellular carcinoma which was 1,578.32 yuan at the highest point in 2013.As for inpatients part,hepatocellular carcinoma and cirrhosis were top 2 in diseases economic burden which were 97,108.00 yuan and 27,870.03 yuan respectively in 2013 at the highest level.(3)Model predicted diseases treatment cost and QALY lossA Decision-Markov model was constructed to evaluated diseases treatment cost and QALY loss in 1992,2002 and 2013 newborn cohorts.In 1992,2002 and 2013,the total prevented diseases treatment cost of HB related diseases were 164.25 million yuan,211.32 million yuan and 671.81 million yuan.The total QALY loss was 14672.48 QALY,13017.94 QALY and 17766.25 QALY respectively.(4)Cost-Utility of universal HB vaccine immunization programThe incremental cost-utility ratio were-1115.81 yuan/QALY?-1514.40yuan/QALY and-3309.04yuan/QALY in 1992,2002 and 2013 respectively,which indicated that the universal HB vaccine immunization program was highly cost utility in these three years and the effect of this policy was stepping forward through that period.(5)Sensitivity analysisThe results of one-way and multi-way sensitivity analysis indicated that whatever the value of parameters had changed could not reverse the conclusion that this policy was cost utility.ConclusionUniversal HB vaccine immunization program was highly cost utility from 1992 to 2013.And the economic effect of universal HB vaccine immunization program would increase with the growth of vaccination rate and direct treatment cost of HB related diseases that resulted from expanding newborn cohort and GDP.Therefore the healthcare cost would lower as the growth of QALY in the future.It is necessary for government to continue investment in universal HB vaccine immunization program. |
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