Evaluating the cost-effectiveness of universal hepatitis B virus vaccination in Iran: a Markov model analysis

Figures & data

Figure 1. Markov model of natural history of hepatitis B virus infection

Figure 2. Markov model for disease natural history related to hepatitis B virus infection

Table 1. Parameter values (per year) used in the Markov model and sensitivity analysis

Parameters	Point estimate	Minimum	Maximum	Distribution	Reference
Annual probabilities for HBV progression
CHB^a to CC^b	0.0243	0.01	0.0488	Beta	[27–29,39,40,41]
CHB to DC^c	0.005	-	-	Beta	[40]
CHB to HCC^d	0.0075	0.004	0.0115	Beta	[5,28,29,39–42]
Death from CHB	0.0065	0.0014	0.009	Beta	[40–42]
CC to DC	0.0498	0.02	0.073	Beta	[5,27–29,39–42]
CC to HCC	0.0209	0.002	0.0391	Beta	[5,27–29,39–42]
Death from CC	0.0377	0.025	0.05	Beta	[5,29,39–42]
DC to HCC	0.0559	0.008	0.091	Beta	[5,28,29,40–42]
Death from DC	0.1935	0.104	0.2506	Beta	[5,27–29,39–42]
Death from HCC	0.4355	0.3173	0.54	Beta	[27,39–42]
Cost data (US$)
Costs^e of CHB	993	662	1324	Gamma	[43,44]
Costs of CC	1522.5	982	2063	Gamma	[43,44]
Costs of DC	6479.5	4179	8780	Gamma	[43,44]
Costs of HCC	17254	10072	24436	Gamma	[43,44]
Vaccination costs per dose	3.20	2.3	4.8	Gamma	[24,45,46]
Health states utilities
Utility CHB	0.73	0.52	0.89	Beta	[30,44,47,48]
Utility CC	0.71	0.57	0.87	Beta	[30,44,47,48]
Utility DC	0.4775	0.26	0.82	Beta	[30,44,47,48]
Utility HCC	0.51	0.31	0.84	Beta	[30,44,47,48]
Discount Rate	0.05	0.03	0.07	Beta	[20,28,31,49,50]
vaccine effectiveness	0.29	0.06	0.46	-	[12]

^aCHB: Chronic hepatitis B; ^b CC: Compensated Cirrhosis; ^c DC: Decompensated Cirrhosis; ^d HCC: Hepatocellular Carcinoma; ^e All costs are expressed per year per person and in 2017 US$ at an official exchange rate of 34066 Iranian Rial = US$ 1.00 (source: Central Bank of the Islamic Republic of Iran. Available at: https://www.cbi.ir/exrates/rates_fa.aspx).

Table 2. Total annual costs of national hepatitis B vaccination program in Iran (2017 USD)

Parameter	USD cost	IRR Cost
National Hepatitis B Vaccination Program in Shiraz	473,506	16,130,287,395
National Hepatitis B vaccination costs per dose	3.20	108,991
National Hepatitis B vaccination costs per fully immunized child	14.26	485,794

Table 3. Cost-effectiveness analysis between universal hepatitis B vaccination and no-vaccination program

Strategy	Viewpoint	Cost^a	QALY^b	ICER^c	Cost	Life-year	ICER
Universal vaccination	Health care	13833.07	14.28	−1183.85	18,001.51	16.86	6319
Non-vaccination	Health care	14919.83	13.37		14,121.95	16.24

^aAll costs are expressed in 2017 US$ at an official exchange rate of 34066 Iranian Rial = US$ 1.00

^bQALY: Quality Adjusted Life Year

^cICER: Incremental Cost-Effectiveness Ratio

Figure 3. Results of Probabilistic Sensitivity Analysis. Simulated results of 1000 replicates of incremental cost-effectiveness ratio for vaccination vs. no-vaccination strategies

Figure 4. Cost-effectiveness acceptability curve for vaccination vs. no-vaccination strategies (Health care payer’s viewpoint). Results based on 1000 Monte Carlo simulations

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