Cost-effectiveness of nationwide hepatitis B catch-up vaccination among children and adolescents in China.
Liver disease and liver cancer associated with childhood-acquired chronic hepatitis B are leading causes of death among adults in China. Despite expanded newborn hepatitis B vaccination programs, approximately 20% of children under age 5 years and 40% of children aged 5 to 19 years remain unprotected from hepatitis B. Although immunizing them will be beneficial, no studies have examined the cost-effectiveness of hepatitis B catch-up vaccination in an endemic country like China. We examined the cost-effectiveness of a hypothetical nationwide free hepatitis B catch-up vaccination program in China for unvaccinated children and adolescents aged 1 to 19 years. We used a Markov model for disease progression and infections. Cost variables were based on data published by the Chinese Ministry of Health, peer-reviewed Chinese and English publications, and the GAVI Alliance. We measured costs (2008 U.S. dollars and Chinese renminbi), quality-adjusted life years, and incremental cost-effectiveness from a societal perspective. Our results show that hepatitis B catch-up vaccination for children and adolescents in China is cost-saving across a range of parameters, even for adolescents aged 15 to 19 years old. We estimate that if all 150 million susceptible children under 19 were vaccinated, more than 8 million infections and 65,000 deaths due to hepatitis B would be prevented.


CONCLUSIONS
The adoption of a nationwide free catch-up hepatitis B vaccination program for unvaccinated children and adolescents in China, in addition to ongoing efforts to improve birth dose and newborn vaccination coverage, will be cost-saving and can generate significant population-wide health benefits. The success of such a program in China could serve as a model for other endemic countries.
Department of Management Science and Engineering, Stanford University, Stanford, CA 94305, USA. david.hutton@stanford.edu
David W
DW
Hutton
Samuel K
SK
So
Margaret L
ML
Brandeau
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002681:China; D003362:Cost-Benefit Analysis; D017325:Hepatitis B Vaccines / Q000191:economics*; D006801:Humans; D007115:Immunization Schedule; D007223:Infant; D014611:Vaccination / Q000191:economics* / Q000706:statistics & numerical data*; D055815:Young Adult
D017325:Hepatitis B Vaccines