A preliminary cost-effectiveness analysis of hepatitis E vaccination among pregnant women in epidemic regions

Figures & data

Table 1. Costs and effectiveness outcomes using the model (10,000 pregnant women).

Scenarios	Total cost ($)	Incremental cost ($)	Total QALYs	Incremental QALYs	ICER^*	ICER^**
Screening and vaccination	1262425.72	−69900.54	9991.91	124.40	<0	<0
Universal vaccination	1339942.66	7616.40	9991.12	123.61	61.61	—
No vaccination	1332326.26	—	9867.51	—	—	—

Note. QALYs: quality adjusted life years; ICER: incremental cost-effectiveness ratio.

* no-vaccination strategy was used as the control;

^** universal vaccination strategy was used as the control.

Figure 1. Results of probabilistic sensitivity analysis The x-coordinate corresponds to the incremental QALYs gained, while the y-coordinate corresponds to the incremental cost saved ($); WTP=3 times China's per capital gross domestic product ($) /QALYsAbbreviations: ICER: incremental cost-effectiveness ratio; QALYs: quality-adjusted life years.

Table 2. Model parameters.

Parameters	Baseline	Range	Source
Probability
Incidence	0.238	0.1727–0.3333	^6,48-50
Symptomatic infection	0.198	0.167–0.229	^5
Seroprevalence of HEV antibody	0.0883	0.005–0.67	^63,64
Probability of non-FHF	0.55	0.19–0.75	^51-53
Probability of FHF	0.45	0.25–−0.81	^51-53
Hospitalization rate	0.328	0.273–0.391	^17,19
Death
Non-FHF
Pregnant woman	0	0.00–0.025	^51-53,57, 58
Fetus^#	0.05	0–0.10	^51-53,57, 58
FHF
Pregnant woman	0.48	0.13–0.79	^54-56
Fetus^#	0.21	0.14–0.38	^54-56
Efficacy of vaccine	0.933	0.721–1	^17,19
Cost ($)
Vaccine (3 doses)	121.33	16.31–146.78	^59,65-67
Administration (3 doses)	3.73	1.47-18	^59, 60,68
Screening	4.08		^59
Outpatient medical cost	134.24	74.98–219.29	^59, 61
Inpatient medical cost
Non-FHF	^2,169.10	^510.46–6,771.39	^59, 61
FHF	1,0581.68	1,025.25–2,7856.49	^60
Medical cost of death
Non-FHF	5,000	2446.26–8,377.96	^21, 24
FHF	13,600	12,000–24,932.46	^22, 62
Fetus	2,956.68	2,446.26–5,000	^21, 24
Work days lost
Outpatient	3.63	3–10	^59, 60
Inpatient
Non-FHF	24	17.47–33.20	^59, 69
FHF	30	17-40	^54
Death	40	20–60	^68
QALYs
Healthy/asymptomatic	1.00		^60, 68
Outpatient	0.83		^24, 60
Non-FHF	0.75		^24, 60
Non-FHF (fetal death)	0.41		^60
FHF	0.42		^60, 70
FHF (fetal death)	0.21		^60
Death	0		^60, 68

Note. HEV: hepatitis E virus; FHF: fulminant hepatic failure; non-FHF: non fulminant hepatic failure; QALYs: quality-adjusted life years.

^# probability of fetal death with maternal survival.

Figure 2. Cost-effectiveness model Abbreviations: HEV: hepatitis E virus; FHF: fulminate hepatitis failure; Non-FHF: non-fulminate hepatitis failure.

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