Cost-effectiveness of nationwide hepatitis B catch-up vaccination among children and adolescents in China

Abstract

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. Conclusion: 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. (HEPATOLOGY 2009.)