Economic evaluation on infant hepatitis B vaccination combined with immunoglobulin in China, 2013

Figures & data

Table 1. Estimated HBV infections and related deaths in universal vaccination combined with HBIG, 2013.

			Prevented
	No vaccination	vaccination combined with HBIG	Number of cases	(%)
Number of HBV infection	12,889,683	397,733	12,491,950	96.91
Number of HBV-related deaths	599,518	23,309	576,209	96.11

Table 2. NB and BCR of universal vaccination combined with HBIG strategy, 2013.

	No vaccination		Vaccination combined with HBIG
	direct	societal	direct	societal
Program cost (billion)	–	–	0.19	0.23
Illness cost (billion)	12.09	46.93	0.42	1.79
Adverted illness cost(billion)	–	–	11.68	45.14
NB (billion)	–	–	11.49	44.91
BCR	–		61.3	193.2

Table 3. The univariate sensitivity analysis.

Parameter	Bound*	direct	societal
Base Case		61.3	193.2
Vaccine prices	lower	62.9	197.4
	upper	54.1	174.4
Wastage rate	lower	61.4	193.6
	upper	61.1	192.8
Administration costs	lower	75.7	228.8
	upper	44.3	147.4
Work loss for vaccination	lower	61.3	212.8
	upper	61.3	176.9
Pregnant woman Screening rate	lower	64.3	200.9
	upper	60.1	190.3
Screening sensitivity and specificity	lower	54.9	176.1
	upper	63.7	199.8
Screening cost	lower	70.5	216.4
	upper	54.2	174.6
Coverage rate	lower	60.2	190.4
	upper	61.3	193.2
Vaccine Efficacy	lower	56.8	179.0
	upper	62.6	197.7
Prenatal infection rate in HBsAg positive mother	lower	60.9	190.8
	upper	61.5	194.6
HBIG injection rate	lower	61.2	193.1
	upper	61.3	193.3
HBIG prices	lower	64.5	201.6
	upper	54.9	176.6
HBV infection rate in pregnant woman	lower	61.4	192.1
	upper	61.1	194.6
Costs of health outcomes	lower	30.8	161.5
	upper	128.1	256.9
Discount rate	lower	142.6	278.6
	upper	41.3	172.5

Figure 1. Decision-tree for the model.

Table 4. Point and interval estimation of parameters in the model.

		Interval Estimation
Parameters	Point Estimation	low	up	Ref.
Newborns in 2013	16,437,497			^27
Vaccination related data
10μg vaccine prices ($/dose)	0.5	0.4	1	^28
HBIG prices ($/dose)	12.92	7.27	25.83	a
Wastage rate of vaccine (%)	2	0	4	^29,30
Administration costs ($/dose)	1.47	0.74	2.11	^31
Work loss for vaccination ($/h)	1.05	0.52	1.57	^32
Pregnant woman screening rate (%)	94.20	80.00	100.00	^33
Screening
cost ( $/person)	2.42	0.81	4.04	^34
Screening reagent sensitivity(%)	96	91	99	^12,35,36
Screening reagent specificity(%)	95	83	99	^12,35,36
Coverage(%)
HepB3 coverage	99.60	95.00	100.00	b
TBD for all newborns	98.00	95.00	99.99	b
TBD for screening HBsAg (+) mothers' newborns	95.88	85.00	99.99	b
HBIG injection rate (%)	91.20	80.00	99.00	report
Efficacy (%)
3 dose for general newborns	97.0	90.0	99.0	^7,37
TBD+HBIG: HBsAg+HBeAg-	94.5	85.1	98.9	^38-41
TBD+HBIG: HBsAg +HBeAg+	91.0	87.0	95.0	^7,41-43
TBD: HBsAg+HBeAg-	93.3	84.0	99.1	^7,39,41
TBD: HBsAg +HBeAg+	83.1	75.0	88.0	^41-43
Duration of protection	lifelong			^2,46,47
AEFI incidence(1/1,000,000 doses)
Thrombocytopenic Purpura	0.03			^c
Angioedema	0.02			^c
AEFI treatment cost ( $/person)
Thrombocytopenic Purpura	617.63			^25
angioedema	513.71			^26
Epidemiology data
HBsAg positive rate among pregnant women	6.61%	5%	7%	^48
HBeAg positive rate among HBsAg(+) women	23.51%	20%	50%	^48
Prenatal infection in HBeAg (+ )mothers	87.5%	70%	90%	^49-52
Prenatal infection in HBeAg (−) mothers	25%	20%	30%	^49-51
Hepatitis B onset proportion after 20 y of neonatal infection	25%			^21
Symptomatic
Prenatal (neonatal)	1%			^2
Early infection(1-5)	10%			^2
Late infection(≥6)	30%			^2
Hospitalization after symptomatic	100%
Fulminant cases among symptomatic
Prenatal (neonatal)	0.10%			^2
Early infection(1-5)	0.60%			^2
Late infection(≥6)	0.60%			^2
Liver transplantation among fulminant	0.1%			^19
Successful transplantation	92%	–	–	^53
Death among fulminant	70%	63%	93%	^17,18
Proportion developing chronic hepatitis
Prenatal (neonatal)	90%	84%	93%	^2,54,55
Early infection(1-5)	30%	23%	40%	^2,54,55
Late infection(≥6)	5%	2.7%	10%	^2,54,55
HBV infected rate in by age-susceptible people	0.13074116-0.01362531×age+0.0004646×age^2-0.00000489×age^3	^16
Transition probabilities (>20 years old)
Natural Clearance of HBV Carriers	1.8%	1%	3%	^56,57
Carrier to CHB:
First year	0.073	–	–	^19
Subsequent years	0.029	–	–	^19
Carrier to CC	0.005			^58
Carrier to HCC	0.0006			^58
CHB to Carrier
First year	0.17324	0.115	0.243	^19,59
Subsequent years	0.105	0.060	0.163	^19,59
CHB to CC	0.129	0.004	0.153	^19,59
CHB to HCC	0.005	0.002	0.007	^19,59
CC to DC	0.054	0.035	0.1	^19,59,60
CC to HCC	0.024	0.01	0.12	^19,59,60
Mortality of CC	0.037	0.03	0.045	^19
DC to HCC	0.024	0.002	0.081	^19
Liver transplantation among DC	0.002
Mortality of DC	0.39	0.3	0.5	^19,59
Liver transplantation among HCC	0.001	–	–
Mortality of HCC	0.56	0.3	0.7	^19,59
Mortality of Liver transplantation	0.06	0.02	0.12	^60,61
Direct Medical costs ( $/year in 2013)
Inactive carrier	105	–	–	^62
Hospitalization for non-fulminant (acute infection)	2,813	1,749	5,853	^62-69
Hospitalization for fulminant	11,066	2,932	13,051	^65-70
CHB	2,830	774	4,086	^62-72
CC	4,012	1,961	7,996	^64,65,67,68,70-72
DC	5,818	2,534	8,875	^64-68,70-72
HCC	6,613	1,772	11,664	^62-72
Liver transplantation (1^st year)	60,189	20,774	63,997	^69,73,74
Liver transplantation (subsequent year)	10,298	–	–	^75
Direct non-Medical costs ($/year in 2013)
Inactive carrier	24	–	–	^62
Hospitalization for non-fulminant (acute infection)	672	118	594	^62,63,65-70
Hospitalization for fulminant	736	326	849	^65-70
CHB	364	80	1,943	^62,64-72
CC	464	204	2,277	^64-68,70-72
DC	640	181	2,589	^64,65,67,68,70-72
HCC	825	222	1,774	^62,64-72
Liver transplantation	680	–	–	^69
Indirect costs ($/year in 2013)
Inactive carrier	83	–	–	^7
Hospitalization for non-fulminant (acute infection)	206	219	753	^66,67,70
Hospitalization for fulminant	1,039	411	1,987	^66,67,70
CHB	515	122	1,153	^64,66,67,70,71
CC	1,240	238	2,208	^64,67,70,71
DC	1,578	352	2,688	^64,67,70,71
HCC	1,787	232	2,636	^64,67,70,71
Liver transplantation (1^st year)	1,431	–	–	^76
Liver transplantation (subsequent year)	83	–	–	^76
Others
Discount rate (%)	3	0	5
Exchange rate in 2013 RMB/USD	6.19			^77

^a. procurement prices by government in 2013

^b. reported coverage data from China Information Management System for Immunization Program

^c. reported data from AEFI Information System in NIP

Figure 2. Markov cohort model for the natural history of HBV infection.

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