Targeted hepatitis E vaccination for women of childbearing age is cost-effective in China. Issue 39 (16th September 2019)

• Record Type: Journal Article
• Authors: Xia, Ruyi; Sun, Shuliu; Shen, Mingwang; Zhang, Lei; Zhuang, Guihua
• Is Part Of: Vaccine. Volume 37:Issue 39(2019)
• Page Start: 5868
• Page End: 5876
• Publication Date: 2019-09-16
• Subjects: HEV 239 -- Cost-effectiveness -- Women of childbearing age -- China; HEV hepatitis E virus -- WHO world health organization -- CI confidence interval -- $ US dollar -- DALY disability-adjusted life-year -- YLL year of life lost -- YLD year lost due to disability -- ICER incremental cost-effectiveness ratio -- WTP willingness-to-pay -- GDP gross domestic product; Vaccines -- Periodicals; 615.372
• DOI: 10.1016/j.vaccine.2019.08.003
• Languages: English
• ISSNs: 0264-410X

Abstract

Abstract: Background: Hepatitis E virus (HEV) infection is hyper-endemic in China, it is characterized with a high morbidity of fulminant hepatitis and mortality in pregnant women. The first hepatitis E vaccine, HEV 239, was licensed in China in 2011 which provides an effective preventive measure. Objective: To evaluate the cost-effectiveness of vaccination with HEV 239 in women of childbearing age in China and whether HEV antibody screening should be considered before vaccination. Methods: A decision tree-Markov model was constructed to simulate HEV infection in a closed female cohort with an average first-marriage age of 25 years and evaluate health and economic outcomes of two potential vaccination strategies, direct vaccination and combined screening and vaccination, from a societal perspective. An incremental cost-effectiveness ratio (ICER, additional costs per disability-adjusted life-year (DALY) averted) was calculated for each vaccination strategy versus no vaccination and between two vaccination strategies. Univariate and probabilistic sensitivity analyses were conducted to assess the robustness of the model findings. Results: ICERs of direct vaccination and combined screening and vaccination versus no vaccination were $4040 and $3114 per DALY averted, respectively, much lower than 1-time Chinese per-capita GDP ($8127). Direct vaccination would need additional $45, 455 for each DALY averted compared with combined screening and vaccination, far more than the 3-time per-capita GDP. Probabilistic sensitivity analyses confirmed our findings that two vaccination strategies would be cost-effective if the willingness-to-pay reached the 1-time per-capita GDP, and that combined screening and vaccination would be more cost-effective than direct vaccination strategy. Conclusion: Vaccinating women of childbearing age with HEV 239 would cost less than the 1-time per-capita GDP for each DALY averted in China, and the vaccination with a prior screening would be the optimal option.