Cost-effectiveness analysis of hepatitis B vaccine booster in children born to HBsAg-positive mothers in rural China

Abstract

Objective: In rural areas of China with highly endemic for hepatitis B virus (HBV) infection, protective efficacy was observed in adulthood when a one-dose HBV vaccine booster was administered to high-risk children born to mothers who were positive for hepatitis B surface antigen (HBsAg). The aim of this study was to estimate the cost-effectiveness of an HBV vaccine booster in this specific group of children when given at 10 years of age. Methods: Two potential strategies were considered: strategy 1 was a one-dose booster given if the child was negative on HBsAg screening; strategy 2 was a one-dose booster given if the child was negative on both HBsAg plus anti-HBs screening. A decision tree combined with a Markov model was developed to simulate the booster intervention process and to simulate the natural history of HBV infection in a cohort of 10-year-old children who were born to HBsAg-positive mothers. The model was calibrated based on multiple selected outcomes. Costs and quality-adjusted life years (QALYs) were measured from a societal perspective. Cost-effectiveness ratios (CERs) of the different strategies were compared in both base-case and one-way sensitivity analyses. Results: Compared to the current practice of 'no screening and no booster', both strategy 1 and strategy 2 were cost-saving, with CERs estimated at US$ À6961 and US$ À6872 per QALY gained, respectively. In the one-way sensitivity analysis for strategy 1, all the CERs were found to be less than US$ À5000 per QALY gained after considering the uncertainty of all the variables, including vaccination protective efficacy, natural history, behavior, and various costs and utility weights. In a 'worst case' scenario (all parameter values simultaneously being at the worst), the CER of strategy 1 increased to US$ 3263 per QALY gained, which was still less than the GDP per capita of China in 2016 (US$ 8126). Conclusions: A hepatitis B vaccine booster given to children born to HBsAg-positive mothers in rural China would be cost-effective and could be considered in HBV endemic areas.

Hepatitis B virus surface gene mutants in immunoprophylaxis‐failed infants from Southern China

“…There were concerns about the vaccine escape related aa substitutions could threaten the effectiveness of HBV vaccine, but the most recent epidemiology data: HBV infection rate among children under five declined from 9.67% in 1992 to 0.32% in 2014, strongly supported the effectiveness of current immunize strategy. 13 Our previously publication about quasispecies characters in infants and their mothers also proved vaccine-escaped variants sourced from their mothers, rather than from the breakthrough after vaccination. 14 serum from infant patients were collected and analyzed, so seroepidemiology information of mother carriers was missed in this study.…”

“…There were concerns about the vaccine escape related aa substitutions could threaten the effectiveness of HBV vaccine, but the most recent epidemiology data: HBV infection rate among children under five declined from 9.67% in 1992 to 0.32% in 2014, strongly supported the effectiveness of current immunize strategy …”

Is it possible to halve the incidence of liver cancer in China by 2050?

“…The first study concluded that boosters delivery in adolescents might be appropriate for high-risk individuals who were born to HBsAg-positive mothers when children's serum anti-HBs <10 mIU/mL; the second study found that HBV vaccine booster given to children born to HBsAg-positive mothers in rural China would be cost-effective and could be considered in HBV endemic areas. 82,83 However, cost-effectiveness of these additional vaccination strategies is an important consideration. For individuals with chronic HBV infection, cirrhosis or other worse conditions, antiviral therapy using nucleot(s)ide analogues are recommended when a patient's serum alanine transaminase was elevated.…”

“…Two local studies have also assessed the effect of a HBV booster vaccine dose delivered to adolescents at risk. The first study concluded that boosters delivery in adolescents might be appropriate for high‐risk individuals who were born to HBsAg‐positive mothers when children's serum anti‐HBs <10 mIU/mL; the second study found that HBV vaccine booster given to children born to HBsAg‐positive mothers in rural China would be cost‐effective and could be considered in HBV endemic areas 82,83 . However, cost‐effectiveness of these additional vaccination strategies is an important consideration.…”

High level of exposure to hepatitis B virus infection in a vulnerable population of a low endemic area: A challenge for vaccination coverage

“…Although HBV vaccine is available and is the most effective strategy to prevent HBV infection (Wang et al, 2018(Wang et al, , 2019Zhu et al, 2018), only 26.2% (95% CI: 21.1-31.4) of the studied population was positive for isolated anti-HBs over 10 mIU/mL (serological HBV vaccination like profile). Age under 26 years associated with the immune response to HBV vaccine was expected, since free hepatitis B vaccine has been provided to all newborns and to high-risk individuals since 1999 and gradually extended to older ages.…”