COST EFFECTIVENESS OF HEPATITIS B CATCH-UP VACCINATION AMONG CHILDREN AND ADOLESCENTS IN CHINA

Purpose: Hepatitis B virus (HBV) is a major public health problem in China: around 9 percent of the population is chronically infected.  Newborn vaccination rates have increased significantly in recent years, but many children and adolescents remain unprotected from HBV.  Our objective was to estimate the cost effectiveness of HBV catch-up vaccination programs for youth in China aged 1 to 19.

Methods: We performed cost-effectiveness analysis using a Markov model for disease progression and probability tree for acute infection.  We looked at the lifetime of the individuals and took a societal perspective of costs and benefits.  We estimated values for model parameters from published literature and expert opinion.  Outcome measures include costs (2007 U.S. dollars), quality-adjusted life years (QALYs), and incremental cost effectiveness.

Results: Catch-up vaccination is highly cost-effective.  For a base cohort of 10-year-olds, catch-up vaccination costs $8,270/QALY gained.   Catch-up vaccination costs less than $20,000/QALY gained over a wide range of parameter estimates.  Results are particularly sensitive to cohort age: vaccination of 1-year-olds costs $1,940/QALY gained; vaccination of 19-year-olds cost $18,372/QALY gained.

Conclusions:  Catch-up HBV vaccination for youth in China is likely to be cost-effective according to World Health Organization criteria and can generate significant population-wide health benefit. The greatest benefits accrue from vaccinating younger children, but vaccination of teenagers is also likely to be cost-effective.  Because one-third of the estimated 350 million cases of chronic HBV infection worldwide occur in China, measures that reduce HBV prevalence and incidence in China can significantly reduce the worldwide prevalence of the virus.