Cost-Effectiveness of Nationwide Hepatitis B Catch-up Vaccination Among Children and Adolescents in China
Unlabelled: 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.
- "Hepatitis B: Several hepatitis B vaccination strategies were found to be cost–saving (Table 1 ). These included universal vaccination comprising of a timely birth dose in a three-dose scheme , catch-up campaigns in individuals aged 1–19 years  or 8–15 years , booster dose programs in adolescents aged 15 years who were negative for hepatitis B vaccine-induced antibody , screening all pregnant women for hepatitis B surface antigen (HBsAg) followed by vaccinating newborn infants of positive mothers with both hepatitis B immune globulin (HBIG) and hepatitis B vaccine , 3-dose 10 g series in children aged 0–6 months , and 3-dose 20 g series in high-risk individuals including health professionals and adults with close household contact with hepatitis B carriers . One study of catch-up campaigns in individuals below 15 years may contain errors because it reported loss of QALYs when a catch-up campaign was added to routine vaccination . "
[Show abstract] [Hide abstract] ABSTRACT: Hepatitis B virus (HBV) infections are perinatally transmitted from chronically infected mothers. Supplemental antiviral therapy during late pregnancy with lamivudine (LAM), telbivudine (LdT), or tenofovir (TDF) can substantially reduce perinatal HBV transmission compared to postnatal immunoprophylaxis (IP) alone. However, the cost-effectiveness of these measures is not clear. Aim. This study evaluated the cost-effectiveness from a societal perspective of supplemental antiviral agents for preventing perinatal HBV transmission in mothers with high viral load (>6 log 10 copies/mL). Methods. A systematic review and network meta-analysis were performed for the risk of perinatal HBV transmission with antiviral therapies. A decision analysis was conducted to evaluate the clinical and economic outcomes in China of four competing strategies: postnatal IP alone (strategy IP), or in combination with perinatal LAM (strategy LAM + IP), LdT (strategy LdT + IP), or TDF (strategy TDF + IP). Antiviral treatments were administered from week 28 of gestation to 4 weeks after birth. Outcomes included treatment-related costs, number of infections, and quality-adjusted life years (QALYs). One- and two-way sensitivity analyses were performed to identify influential clinical and cost-related variables. Probabilistic sensitivity analyses were used to estimate the probabilities of being cost-effective for each strategy. Results. LdT + IP and TDF + IP averted the most infections and HBV-related deaths, and gained the most QALYs. IP and TDF + IP were dominated as they resulted in less or equal QALYs with higher associated costs. LdT + IP had an incremental $2,891 per QALY gained (95% CI [$932–$20,372]) compared to LAM + IP (GDP per capita for China in 2013 was $6,800). One-way sensitivity analyses showed that the cost-effectiveness of LdT + IP was only sensitive to the relative risk of HBV transmission comparing LdT + IP with LAM + IP. Probabilistic sensitivity analyses demonstrated that LdT + IP was cost-effective in most cases across willingness-to-pay range of $6,800 ∼ $20,400 per QALY gained. Conclusions. For pregnant HBV-infected women with high levels of viremia, supplemental use of LdT during late pregnancy combined with postnatal IP for infants is cost-effective in China.
- "treatment 15.0% 5.0–30.0% Hutton, So & Brandeau, 2010 Receiving treatment with durable response 50.0% 0.0–100% Hutton, So & Brandeau, 2010 Durable response relapse to elevated ALT 7.0% 2.0–15.0% Hutton, So & Brandeau, 2010 Durable response relapse to HCC 0.3% 0.2–0.5% Hutton, So & Brandeau, 2010 Compensated to decompensated cirrhosis 7.0% 3.0–10.0% Hutton, So & Brandeau, 2010 Mortality from compensated cirrhosis 4.8% 2.0–13.1% Hutton, So & Brandeau, 2010 Mortality drug resistance (Brown et al., 2012; Fontana, 2009; Wang et al., 2013; Yi, Liu & Cai, 2012; Ayres et al., 2014; Ho & Tran, 2011). For those who did not fully comply, the risk of HBV transmission was assumed to equal that of IP alone. For mothers wh"
[Show abstract] [Hide abstract] ABSTRACT: Chronic liver disease and liver cancer associated with chronic hepatitis B (CHB) are leading causes of death among adults in China. Although newborn hepatitis B immunization has successfully reduced the prevalence of CHB in children, about 100 million Chinese adults remain chronically infected. If left unmanaged, 15-25% will die from liver cancer or liver cirrhosis. Antiviral treatment is not necessary for all patients with CHB, but when it is indicated, good response to treatment would prevent disease progression and reduce disease mortality and morbidity, and costly complications. The aim of this study is to analyze the cost-effectiveness of generic and brand antiviral drugs for CHB treatment in China, and assessing various thresholds at which a highly potent, low resistance antiviral drug would be cost-saving and/or cost-effective to introduce in a national treatment program. We developed a Markov simulation model of disease progression using effectiveness and cost data from the medical literature. We measured life-time costs, quality adjusted life years (QALYs), incremental cost-effectiveness ratios (ICERs), and clinical outcomes. The no treatment strategy incurred the highest health care costs ($12,932-$25,293) per patient, and the worst health outcomes, compared to the antiviral treatment strategies. Monotherapy with either entecavir or tenofovir yielded the most QALYs (14.10-19.02) for both HBeAg-positive and negative patients, with or without cirrhosis. Threshold analysis showed entercavir or tenofovir treatment would be cost saving if the drug price is $32-75 (195-460 RMB) per month, highly cost-effective at $62-110 (379-670 RMB) per month and cost-effective at $63-120 (384-734 RMB) per month. This study can support policy decisions regarding the implementation of a national health program for chronic hepatitis B treatment in China at the population level.
- "In comparison to HIV, which affects 600,000 Chinese, an estimated 100 million Chinese are living with chronic hepatitis B, making it the most prevalent life threatening chronic infection in China . Major progress has been made in China to reduce the prevalence of chronic hepatitis B in children through a robust new born immunization program, and a recent nationwide catch up vaccination program for unprotected children [4, 5]. Although hepatitis B vaccination clearly contributed to the reduction of new cases, it does not address the healthcare needs of the chronically-infected individuals who are at risk of disease progression leading to the development of HCC and cirrhosis. "