Cost-utility analysis of newborn hepatitis B immunization in Beijing

Figures & data

Figure 1. Decision-Markov model of universal vaccination and nonvaccination program

Figure 2. Prognosis of HBV-infected infants

Figure 3. Prognosis of HBV-susceptible infants

Table 1. Parameters of decision-Markov models

	Base value	Range	Distribution	Reference
Chort size	202349	-	-	24
Life span	82	-	-	25
Vaccination rate (first dose)	0.9995	0.9990–1.00	Triangular	Estimated
Rate of vaccine efficacy(Hep3)	0.977	0.932–0.995	Triangular	26
Transition probablity
HBsAg positive rate among mothers Perinatal infection rate of HBsAg mothers	0.031	0.01–0.0386		5,22,27
Universal vaccination	0.059	0.037–0.0926	Triangular	28–30
Nonvaccination	0.4034	0.3228–0.484	Triangular	31
Incidence of AHB ≥1 year	0.03	±50%	Triangular	32
AHB to carriers
<1	0.89	-	-	33
≥1	e^(−0.65*age^0.46)	-	-
Symptomatic		-	-	34
Age<1	0.01	-	-
1≤ age<10	0.1	-	-
Age≥ 11	0.3	-	-
AHB to CHB		-	-
Age≤5	0.25	-	-	35
6≤ age<19	0.06	-	-	36
Age≥20	0.04	-	-	36
Mortality of AHB	0.0041	0.003–0.015	Triangular	22,32
HBV Carriers to immunity		-	-
Age<20	0.012	-	-	34,37
Age≥20	0.0226	-	-	38
HBV Carriers to CHB	0.0269	-	-	39
HBV Carriers to Cirrhosis	0.001	-	-	19
HBV Carriers to HCC	0.002	0.0005–0.0061	Triangular	36
CHB to immunity	0.0005	-	-	32
CHB to cirrhosis	0.02	0.0081–0.027	Triangular	32,34,36
CHB to HCC	0.005	0.003–0.0064	Triangular	34,36
Mortality of CHB	0.014	0.0077–0.0158	Triangular	32,40
Cirrhosis to HCC	0.0465	0.028–0.066	Triangular	22,36
Mortality of cirrhosis	0.0663	0.0243–0.3932	Triangular	32,40
Mortality of HCC	0.5	0.081–0.545	Triangular	22,32,41
Mortality of other causes	Sample Survey Data of 1% of Population in 2015 in Beijing			42
Cost of vaccination (CNY/per dose)	36.86	±25%	Triangular	43
Cost of direct medical treatment(CNY)				Estimated
AHB	16,316.06	±25%	Triangular
CHB	14,743.24	±25%	Triangular
Cirrhosis	32,304.96	±25%	Triangular
HCC	112,324.15	±25%	Triangular
HBV carrier	761.95	±25%	Triangular
Discount rate	0.03	0.00–0.05	Triangular	44
Utility				32
Acute hepatitis B	0.892	±0.142	β
Chronic hepatitis B	0.912	±0.136	β
Cirrhosis	0.755	±0.209	β
Hepatocellular carcinoma	0.712	±0.254	β
HBV Carrier	0.968	±0.081	β

note: 1CNY = 0.15377US dollar in 2016⁴⁵

Table 2. Average cost and QALYs gains and ICUR of two scenarios

Strategy	Average cost(CNY)	Average QALY gains	ICUR
Unversal vaccination	543.05	30.10	−24,576.61
Unvaccination	11,615.52	29.65
Incremental value	−11,072.47	0.45

Table 3. Direct treatment cost and QALY loss of HB-related patients under different scenarios

	Direct treatment cost (CNY)			Loss of QALYs
HB diseases	Universal vaccination	Nonvaccination	Prevented value	Universal vaccination	No vaccination	Prevented value
AHB	6,417,040.52	292,636,257.07	286,219,216.55	43.82	1998.19	1954.37
CHB	47,407,437.29	1,213,027,955.08	1,165,620,517.79	281.70	7188.84	6907.14
Cirrhosis	16,124,433.30	408,475,499.25	392,351,065.95	120.81	3032.88	2912.07
HCC	11,661,511.70	291,868,298.68	280,206,786.98	29.10	708.27	679.17
HBV carrier	5,910,016.05	144,381,602.28	138,471,586.23	249.40	6118.90	5869.50
total	87,520,438.86	2,350,389,612.36	2,262,869,173.50	724.83	19047.08	18322.25

Figure 4. Incremental cost-utility plane for vaccination vs. nonvaccination from healthcare perspective of 5000 simulations

Table A1. Characteristics of socio-demographic variables of HB-related patients in 2016

	AHB		CHB		Cirrhosis		HCC		HBV Carriers
	Outpatient (%)	Inpatient (%)	Outpatient (%)	Inpatient (%)	Outpatient (%)	Inpatient (%)	Outpatient (%)	Inpatient (%)	Outpatient (%)	Total (%)
Gender (%)
Male	41(67.21)	21(63.64)	69685(65.11)	1277(68.25)	4986(63.55)	1214(70.62)	346(73.15)	863(81.11)	1854(41.51)	80287(64.46)
Female	20(32.79)	12(36.36)	37335(34.89)	594(31.75)	2860(36.45)	505(29.38)	127(26.85)	201(18.89)	2612(58.49)	44266(35.54)
Age group (%)
x ≤ 30	22(36.07)	5(15.15)	20156(18.83)	482(25.76)	223(2.84)	24(1.4)	12(2.54)	6(0.56)	1731(38.76)	22661(18.19)
30 < x ≤ 40	18(29.51)	14(42.42)	32656(30.51)	535(28.59)	652(8.31)	125(7.27)	5(1.06)	26(2.44)	1580(35.38)	35611(28.59)
40 < x ≤ 50	15(24.59)	5(15.15)	22.90	434(23.2)	1678(21.39)	339(19.72)	77(16.28)	135(12.69)	711(15.92)	27903(22.4)
50 < x ≤ 60	1(1.64)	5(15.15)	18931(17.69)	279(14.91)	2738(34.9)	648(37.7)	173(36.58)	414(38.91)	333(7.46)	23522(18.89)
60 < x	11.90	3(9.09)	10768(10.06)	119(6.36)	2555(32.56)	575(33.45)	206(43.55)	481(45.21)	111(2.49)	14823(11.9)
Missing value	0(0)	1(3.03)	0(0)	22(1.18)	0(0)	8(0.47)	0(0)	2(0.19)	0(0)	33(0.03)
Total	61(100)	33(100)	107020(100)	1871(100)	7846(100)	1719(100)	473(100)	1064(100)	4466(100)	124553(100)

^aICD-10code of HB-related diseases: AHB-B16, CHB-B18, Cirrhosis-K74, HCC-C22, HBV carrier-Z22

^bAverage age of outpatients/inpatients: 43.18/49.99

^cMissing value represented individuals whose information of age was lost but with complete information of medical charge.

Figure A1. Selective standard of out/inpatients from beijing health and medical price monitoring data platform

Table A2. Death rate data of 1% of population in 2015 in Beijing

Age group	Total population	Death population	Death rate (‰)
0–4	15569	2	0.128460402
5–9	12720	-	-
10–14	8092	-	-
15–19	10719	-	-
20–24	22750	2	0.087912088
25–29	36373	7	0.192450444
30–34	35943	3	0.083465487
35–39	27723	9	0.32464019
40–44	26742	10	0.373943609
45–49	26127	22	0.842040801
50–54	26904	50	1.858459709
55–59	23959	53	2.212112359
60–64	22325	65	2.911534155
65–69	13996	78	5.573020863
70–74	9079	124	13.65789184
75–79	8709	185	21.24239293
80–84	5757	231	40.12506514
85–89	2411	171	70.92492742
90–94	687	81	117.9039301
95–99	130	23	176.9230769
100~	21	5	238.0952381
total	336729	1120	3.326116848

Beijing 1% population sample survey in 2015. (2017). Office for Beijing 1% Population Sample Survey, Beijing Municipal Bureau of Statistics. China Statistics Press.

Table A3. Direct treatment cost in 2016 in Beijing (CNY)

HB diseases	Outpatient	Inpatient	Total
AHB	1,113.30	15,202.76	16,316.06
CHB	1,958.91	12,784.33	14,743.24
Cirrhosis	1,579.30	30,725.66	32,304.96
HCC	2,078.17	110,245.98	112,324.15
HBV carrier	761.95	-	761.95

The annual direct treatment cost of HB-related diseases was deduced by multiplying direct treatment cost for per visit and average visit times per year of HB-related out/inpatients. The average visit times per year of out/inpatients due to HCC and other four kinds of HB-related diseases were 1.38/2.39 and 1.52/1.08 respectively, which was deduced by employing data from National Health Services Surveys in 2013.

Jian Z, Economics SO, University NN. A study of the impacts of rmb exchange rate volatility adjustment on rmb exchange rate volatility mechanism. Review of Economy and Management; 2018.

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