Method: A decision analytic tree and a long-term Markov model represented the risk of perinatal and early childhood (“postnatal” ages 1 to 5 years-old) infections under different vaccination alternatives, and the long-term health and economic consequences of hepatitis B infection. Outcome measures were the number of perinatal infections and postnatal infections from infants born to HBsAg-positive women, quality-adjusted life years (QALYs), lifetime costs, and incremental cost per QALY gained. The health outcomes and total costs of each strategy were compared in the form of incremental cost effectiveness ratios (ICERs). Costs were evaluated from the health care system perspective and expressed in U.S. dollars at a 2010 price base. Probabilistic sensitivity analysis was conducted to incorporate uncertainty in model parameters. Uncertainty in the model was described using cost-effectiveness acceptability curves. One-way sensitivity analyses were conducted to estimate the impact of changing each key parameter individually. A series of multi-way sensitivity analyses changed several variables simultaneously to create hypothetical scenarios.
Result: In all analyses, the PHBPP increased QALYs and led to higher reductions in the number of perinatal and postnatal infections than the alternative strategies. Compared with Strategy 2, the PHBPP was associated with 2,351 fewer total infections (1,485 perinatal and 866 postnatal), 2,304 less QALYs lost, and an ICER of $2,602 per QALY. When the PHBPP was compared with a hypothetical scenario of no prevention, it was associated with 9,159 fewer total infections (5,902 perinatal and 3,257 postnatal), 8,772 fewer QALYs lost, and an ICER of $1,785 per QALY. In sensitivity analyses, the cost-effectiveness ratios were robust to variations in model inputs, including instances where the program was both more effective and cost saving.
Conclusion: This study indicated that the current PHBPP represents a cost-effective use of resources. Ensuring the program reaches all pregnant women could prevent further hepatitis B-related morbidity and mortality.