Targeted hepatitis E vaccination for women of childbearing age is cost-effective in China

Ruyi Xia; Shuliu Sun; Mingwang Shen; Lei Zhang; Guihua Zhuang

doi:10.1016/j.vaccine.2019.08.003

Targeted hepatitis E vaccination for women of childbearing age is cost-effective in China

Vaccine. 2019 Sep 16;37(39):5868-5876. doi: 10.1016/j.vaccine.2019.08.003. Epub 2019 Aug 20.

Authors

Ruyi Xia¹, Shuliu Sun², Mingwang Shen³, Lei Zhang⁴, Guihua Zhuang⁵

Affiliations

¹ Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, China. Electronic address: xiaruyi0820@163.com.
² Department of Obstetrics, Northwest Women's and Children's Hospital, Xi'an, Shaanxi 710061, China. Electronic address: shuliu0823@outlook.com.
³ Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, China. Electronic address: mingwangshen521@xjtu.edu.cn.
⁴ Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, China; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia; Central Clinical School, Faculty of Medicine, Monash University, Melbourne, Australia; School of Public Health and Preventive Medicine, Faculty of Medicine, Monash University, Melbourne, Australia. Electronic address: lei.zhang1@xjtu.edu.cn.
⁵ Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, China. Electronic address: zhuanggh@mail.xjtu.edu.cn.

PMID: 31443991
DOI: 10.1016/j.vaccine.2019.08.003

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.

Keywords: China; Cost-effectiveness; HEV 239; Women of childbearing age.

MeSH terms

China
Cost-Benefit Analysis / economics
Female
Hepatitis E / economics*
Hepatitis E / immunology*
Hepatitis E virus / immunology*
Humans
Quality-Adjusted Life Years
Vaccination / economics*