Hui Jin, Department of Epidemiology and Health Statistics; Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu 210009, China.

Email: [email protected]

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Tingting Cui,

Tingting Cui

orcid.org/0000-0001-8242-6045

Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China

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Xuefeng Zhang,

Xuefeng Zhang

Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China

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Qiang Wang,

Qiang Wang

Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China

Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, China

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Na Yue,

Na Yue

Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China

Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, China

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Changjun Bao,

Changjun Bao

Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China

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Renjie Jiang,

Renjie Jiang

Yancheng Center for Disease Control and Prevention, Yancheng, China

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Shilin Xu,

Shilin Xu

Yancheng Center for Disease Control and Prevention, Yancheng, China

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Zhaohu Yuan,

Zhaohu Yuan

Zhenjiang Center for Disease Control and Prevention, Zhenjiang, China

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Yunke Qian,

Yunke Qian

Zhenjiang Center for Disease Control and Prevention, Zhenjiang, China

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Liling Chen,

Liling Chen

Suzhou Center for Disease Control and Prevention, Suzhou, China

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Hui Hang,

Hui Hang

Suzhou Center for Disease Control and Prevention, Suzhou, China

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Zhong Zhang,

Zhong Zhang

Nanjing Center for Disease Control and Prevention, Nanjing, China

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Hongmin Sun,

Hongmin Sun

Nanjing Center for Disease Control and Prevention, Nanjing, China

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Hui Jin,

Corresponding Author

Hui Jin

[email protected]

Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China

Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, China

Correspondence

Email: [email protected]

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First published: 14 September 2023

https://doi.org/10.1111/hepr.13967

Citations: 2

Tingting Cui and Xuefeng Zhang are equal contributors.

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Abstract

Aim

This study aimed to evaluate the cost-effectiveness of hepatitis E vaccination strategies in chronic hepatitis B (CHB) patients.

Methods

Based on the societal perspective, the cost-effectiveness of three hepatitis E vaccination strategies—vaccination without screening, screening-based vaccination, and no vaccination—among CHB patients was evaluated using a decision tree–Markov model, and incremental cost-effectiveness ratios (ICERs) were calculated. Values for treatment costs and health utilities were estimated from a prior investigation on disease burden, and values for transition probabilities and vaccination-related costs were obtained from previous studies and government agencies. Sensitivity analyses were undertaken for assessing model uncertainties.

Results

It was estimated that CHB patients superinfected with hepatitis E virus (HEV) incurred significantly longer disease course, higher economic burden, and more health loss compared to those with HEV infection alone (all p < 0.05). The ICERs of vaccination without screening and screening-based vaccination compared to no vaccination were 41,843.01 yuan/quality-adjusted life year (QALY) and 29,147.32 yuan/QALY, respectively, both lower than China's per-capita gross domestic product (GDP) in 2018. The screening-based vaccination reduced the cost and gained more QALYs than vaccination without screening. One-way sensitivity analyses revealed that vaccine price, vaccine protection rate, and decay rate of vaccine protection had the greatest impact on the cost-effectiveness analysis. Probabilistic sensitivity analyses confirmed the base-case results, and if the willingness-to-pay value reached per-capita GDP, the probability that screening-based vaccination would be cost-effective was approaching 100%.

Conclusions

The disease burden in CHB patients superinfected with HEV is relatively heavy in China, and the screening-based hepatitis E vaccination strategy for CHB patients is the most cost-effective option.

Graphical Abstract

The cost-effectiveness of hepatitis E vaccination for patients with chronic hepatitis B (CHB) is unclear. We developed a decision tree–Markov model to assess the cost-effectiveness of three hepatitis E vaccination strategies among these patients. We found that the disease burden in CHB patients superinfected with hepatitis E virus is relatively heavy in China, and the screening-based hepatitis E vaccination strategy for CHB patients is the most cost-effective option.

CONFLICT OF INTEREST STATEMENT

Authors declare no Conflict of Interests for this article.

Open Research

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Supporting Information

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Volume54, Issue2

February 2024

Pages 142-150