Cost-Effectiveness of Nationwide Hepatitis B Catch-up Vaccination Among Children and Adolescents in China

Department of Management Science and Engineering, Stanford University, Stanford, CA 94305, USA.
Hepatology (Impact Factor: 11.19). 02/2010; 51(2):405-14. DOI: 10.1002/hep.23310
Source: PubMed

ABSTRACT Liver disease and liver cancer associated with childhood-acquired chronic hepatitis B are leading causes of death among adults in China. Despite expanded newborn hepatitis B vaccination programs, approximately 20% of children under age 5 years and 40% of children aged 5 to 19 years remain unprotected from hepatitis B. Although immunizing them will be beneficial, no studies have examined the cost-effectiveness of hepatitis B catch-up vaccination in an endemic country like China. We examined the cost-effectiveness of a hypothetical nationwide free hepatitis B catch-up vaccination program in China for unvaccinated children and adolescents aged 1 to 19 years. We used a Markov model for disease progression and infections. Cost variables were based on data published by the Chinese Ministry of Health, peer-reviewed Chinese and English publications, and the GAVI Alliance. We measured costs (2008 U.S. dollars and Chinese renminbi), quality-adjusted life years, and incremental cost-effectiveness from a societal perspective. Our results show that hepatitis B catch-up vaccination for children and adolescents in China is cost-saving across a range of parameters, even for adolescents aged 15 to 19 years old. We estimate that if all 150 million susceptible children under 19 were vaccinated, more than 8 million infections and 65,000 deaths due to hepatitis B would be prevented. CONCLUSION: The adoption of a nationwide free catch-up hepatitis B vaccination program for unvaccinated children and adolescents in China, in addition to ongoing efforts to improve birth dose and newborn vaccination coverage, will be cost-saving and can generate significant population-wide health benefits. The success of such a program in China could serve as a model for other endemic countries.

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    PLoS Medicine 12/2014; 11(12):e1001774. DOI:10.1371/journal.pmed.1001774 · 14.00 Impact Factor
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    ABSTRACT: When deciding which programs to invest in, public health decision makers face a number of challenges including limited resources, competing objectives (e.g., maximize health, achieve equity), and limited information about uncertain events. Despite these difficulties, public health planners must make choices about which programs they will invest in – and the quality of these choices affects the health benefits achieved in the population. To support good decisions, information about the likely costs and health consequences of alternative interventions is needed. This is where OR-based modeling can play a role: by providing a structured framework that uses the best available evidence, imperfect as it may be, and that captures relevant uncertainties, complexities, and interactions, OR-based models can be used to evaluate the potential impact of alternative public health programs. This chapter describes modeling efforts in which OR has played and can play a role in informing public health decision making. We describe work in three areas: hepatitis B control, HIV control, and bioterrorism preparedness and response. We conclude with a discussion of lessons learned.
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    ABSTRACT: Hepatitis B immunization programs for newborns, children, and adolescents in China have shown remarkable results. To establish whether there would be any benefit in extending the program to cover older individuals, we examined both the epidemiology of hepatitis B virus (HBV) infection and the coverage of hepatitis B vaccinations among adults born before routine vaccinations were implemented. We then evaluated the impact of hepatitis B vaccination in adults aged 20-59 years. A large-scale cross-sectional epidemiological survey of HBV infection was performed in the province of Jiangsu, south-east China, between September 2009 and March 2010. A total of 86,732 adults aged 20-59 years were included, of which 8,615 (9.9%, 95% CI = 9.7-10.1%) were HBsAg sero-positive. Self-reported vaccination status suggested that the coverage was approximately 23.7% (95% CI = 23.4-24.0%). It was shown that higher HBV vaccination coverage was associated with a lower rate of HBsAg seropositivity among adults. There was a negative correlation between hepatitis B vaccination coverage and HBsAg prevalence (correlation coefficient = -0.805, p = 0.016), which might demonstrate the combined effects of vaccination and pre-vaccination HBsAg screening. In the unvaccinated group, the HBsAg-positive rate had an obvious upward trend with age growing among 20-39 year-olds (Trend χ2 = 22.605, P<0.001), while the vaccinated group showed no such trend (Trend χ2 = 3.462, P = 0.063). Overall, hepatitis B vaccination in adults might reduce the rate of HBsAg positivity. Therefore, routine immunization of adults aged 20-39 years should be seriously considered.
    PLoS ONE 06/2014; 9(6):e101501. DOI:10.1371/journal.pone.0101501 · 3.53 Impact Factor


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