title: Assessment of cost-effectiveness of universal hepatitis B immunization in a low-income country with intermediate endemicity using a Markov model.
abstract: OBJECTIVE
  Most countries with high hepatitis B (HB) virus endemicity and most high-income countries have introduced immunization programmes against this infection. However, several low-income countries with intermediate HB endemicity have not done so. We performed a cost-effectiveness analysis of universal childhood HB immunization in such countries using India as an example, since available data on this aspect are limited.
  
  
  METHODS
  Marginal cost of every life-year and quality-adjusted life-year (QALY) gained with universal HB vaccination was calculated using a Markov model. Two types of analyses (including and excluding expenditure on treatment of long-term complications of HB infection) were done. Several sensitivity analyses and Monte-Carlo simulation were performed.
  
  
  RESULTS
  Universal immunization reduced the HB carrier rate by 71%, and increased the number of years and QALY lived by a birth-cohort by 0.173 years (61.072 vs. 60.899 years) and 0.213 years (61.056 vs. 60.843 years), respectively. Marginal costs were US$16.27 per life-year gained and US$13.22 per QALY gained, much lower than annual per capita income. One-way sensitivity analysis and Monte-Carlo simulation confirmed the robustness of the conclusions.
  
  
  CONCLUSIONS
  Universal HB immunization is highly cost-effective in low-income countries with intermediate endemicity rates.
authors.affiliation: Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India. rakesh@sgpgi.ac.in
authors.forename: Rakesh
authors.initials: R
authors.lastname: Aggarwal
authors.forename: Uday C
authors.initials: UC
authors.lastname: Ghoshal
authors.forename: Subhash R
authors.initials: SR
authors.lastname: Naik
mesh_terms: D003362:Cost-Benefit Analysis; D003906:Developing Countries / Q000191:economics; D018450:Disease Progression; D019353:Endemic Diseases / Q000191:economics / Q000517:prevention & control*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006509:Hepatitis B / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D017325:Hepatitis B Vaccines / Q000191:economics*; D006801:Humans; D017589:Immunization Programs / Q000191:economics*; D007194:India / Q000453:epidemiology; D008390:Markov Chains; D017059:Models, Econometric; D009010:Monte Carlo Method; D011203:Poverty; D015397:Program Evaluation; D019057:Quality-Adjusted Life Years; D026712:Value of Life / Q000191:economics
chemical_list: D017325:Hepatitis B Vaccines