Probabilistic cost-effectiveness analysis of the long-term effect of universal hepatitis B vaccination: an experience from Taiwan with high hepatitis B virus infection and Hepatitis B e Antigen positive prevalence.
OBJECTIVE
To assess cost-effectiveness of hepatitis B virus (HBV) vaccination strategies from health care payer and societal perspectives, focusing on the long-term effect, in Taiwan where prevalence of HBV and Hepatitis B e Antigen (HBeAg) is high.


METHODS
A decision analysis was performed to compare total costs and effectiveness between two vaccination strategies: universal vaccination and no-vaccination. The Markov process was defined as a series of states including acute HBV infection, asymptomatic carrier, chronic hepatitis, compensated and decompensated liver cirrhosis, hepatoma, and death. Direct and indirect costs were also imputed based on estimates. The incremental cost-effectiveness ratio (ICER) per life-year gained and quality-adjusted life years gained were calculated at a 3% discount rate. By assigning a series of specific distributions to each parameter, a probabilistic cost-effective analysis using Monte Carlo simulation was conducted to yield 5000 ICER replicates.


RESULTS
The effectiveness of a universal vaccination program for reducing hepatocellular carcinoma cases and deaths was approximately 86%. The average life years gained per subject as a result of such a universal vaccination was 3.9. The vaccination program dominated over a no-vaccination program (less cost and more effectiveness).


CONCLUSIONS
A universal vaccination program against hepatitis B infection is not only effective for reducing long-term sequelae but is also a cost-saving primary preventive strategy, which supports a universal infant immunization in endemic area with high prevalence of HBV and HBeAg.
Hung
Hui-Fang
HF
Institute of Preventive Medicine, National Taiwan University, Taiwan.
Chen
Tony Hsiu-Hsi
TH
D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D006509:Hepatitis B / Q000453:epidemiology* / Q000517:prevention & control; D017325:Hepatitis B Vaccines / Q000191:economics*; D006513:Hepatitis B e Antigens / Q000276:immunology; D006801:Humans; D017589:Immunization Programs / Q000191:economics*; D007223:Infant; D007231:Infant, Newborn; D008390:Markov Chains; D032541:Mass Vaccination; D018803:Models, Economic; D009010:Monte Carlo Method; D015995:Prevalence; D019057:Quality-Adjusted Life Years; D013624:Taiwan / Q000453:epidemiology
D017325:Hepatitis B Vaccines; D006513:Hepatitis B e Antigens