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: 11.06). 02/2010; 51(2):405-14. DOI: 10.1002/hep.23310
Source: PubMed


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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    • "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 [30], catch-up campaigns in individuals aged 1–19 years [25] or 8–15 years [34], booster dose programs in adolescents aged 15 years who were negative for hepatitis B vaccine-induced antibody [38], 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 [40], 3-dose 10 g series in children aged 0–6 months [37], and 3-dose 20 g series in high-risk individuals including health professionals and adults with close household contact with hepatitis B carriers [43]. 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 [39]. "
    Full-text · Dataset · Apr 2016
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    • "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: 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.
    Full-text · Article · Mar 2016 · PeerJ
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    • "Societal Girls aged 9–12 years HPV-16/18 vaccine vs. no vaccine US$626 per DALY averted at a cost of US$12 per vaccinated girls 2005 Zhuang et al. [23] Societal and healthcare Children 12–18 months Universal hepatitis A vaccine vs. no vaccine Cost-saving or cost-effective depending on region 2005 Wang et al. [24] Societal and patient Children 0–6 months in rural Zhengding County Rotavirus vaccine compared with no vaccine Cost saving 2004 Hutton et al. [25] Societal Children 1–19 years Catch-up hepatitis B vaccine vs. current program Cost saving 2008 Lee et al. [26] Healthcare Children 6 months—5 years Enterovirus 71 vaccine vs. no vaccine Cost-effective at a price of US$27 per vaccine dose and efficacy ≥70% or US$11 per dose and efficacy ≥50%. In areas with higher infection risk, cost-effective at a price of US$54–82 per dose and efficacy ≥50% 2010 Chen [38] Healthcare 10,000 children aged 15 years Booster dose in children negative for hepatitis B vaccine induced antibody vs. no booster. "
    [Show abstract] [Hide abstract] ABSTRACT: The purpose of the study was to systematically review economic evaluations of vaccine programs conducted in mainland China. We searched for economic evaluations of vaccination in China published prior to August 3, 2015 in eight English-language and three Chinese-language databases. Each article was appraised against the 19-item Consensus on Health Economic Criteria list (CHEC-list). We found 23 papers evaluating vaccines against hepatitis B (8 articles), Streptococcus pneumoniae (5 articles), human papillomavirus (3 articles), Japanese encephalitis (2 articles), rotavirus (2 articles), hepatitis A (1 article), Enterovirus 71 (1 article) and influenza (1 article). Studies conformed to a mean of 12 (range: 6-18) items in the CHEC-list criteria. Five of six Chinese-language articles conformed to fewer than half of the 19 criteria items. The main criteria that studies failed to conform to included: inappropriate measurement (20 articles) and valuation (18 articles) of treatment and/or vaccination costs, no discussion about distributional implications (18 articles), missing major health outcomes (14 articles), no discussion about generalizability to other contexts (14 articles), and inadequate sensitivity analysis (13 articles). In addition, ten studies did not include major cost components of vaccination programs, and nine did not report outcomes in terms of life years even in cases where QALYs or DALYs were calculated. Only 13 studies adopted a societal perspective for analysis. All studies concluded that the appraised vaccination programs were cost-effective except for one evaluation of universal 7-valent pneumococcal conjugate vaccine (PCV-7) in children. However, three of the five studies on PCV-7 showed poor overall quality, and the number of studies on vaccines other than hepatitis B vaccine and PCV-7 was limited. In conclusion, major methodological flaws and reporting problems exist in current economic evaluations of vaccination programs in China. Local guidelines for good practice and reporting, institutional mechanisms and education may help to improve the overall quality of these evaluations.
    Full-text · Article · Oct 2015 · Vaccine
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