Abstract
BackgroundTo tackle the high prevalence of Hepatitis B virus (HBV) infection in North Korea, it is essential that birth doses of HBV vaccines should be administered within 24 hours of birth. As the country fails to provide a Timely Birth Dose (TBD) of HBV vaccine, the efforts of reducing the high prevalence of HBV have been significantly hampered.MethodsTo examine the cost-effectiveness of vaccination strategies to prevent perinatal transmission of HBV in North Korea, we established a decision tree with a Markov model consisting of selective, universal, and the country’s current vaccination program against HBV. The cost-effectiveness analysis was performed from societal and payer’s perspectives and evaluated by Disability Adjusted Life Year (DALY).ResultsThe results suggest that introducing the universal vaccination would prevent 1,866 cases of perinatal infections per 100,000 of the birth cohort of 2013. Furthermore, 900 cases of perinatal infections per 100,000 could be additionally averted if switching to the selective vaccination. The current vaccination is a dominated strategy both from the societal and payer’s perspective. The Incremental Cost-Effectiveness Ratio (ICER) between universal and selective vaccination is $267 from the societal perspective and is reported as $273 from the payer’s perspective.ConclusionBased on the assumption that the 2012 Gross Domestic Product (GDP) per capita in North Korea, $582.6 was set for cost-effectiveness criteria, the result of this study indicates that selective vaccination may be a highly cost-effective strategy compared to universal vaccination.
Highlights
Cost-Effectiveness of Hepatitis B Vaccination in North Korea indicates that selective vaccination may be a highly cost-effective strategy compared to universal vaccination
Tackling Hepatitis B virus (HBV) infection is an important global health challenge, especially for developing countries [1]. In such countries suffering from high prevalence of HBV, perinatal transmission from mothers to newborns serves as a major source of infection [2]
70 to 90% of people infected with HBV during the perinatal period are likely to develop chronic hepatitis which places a heavy burden on the health system of the developing countries; whereas the risk of chronic disease reduced significantly to 5–10% if infection occurs in adults [2,3]
Summary
Tackling Hepatitis B virus (HBV) infection is an important global health challenge, especially for developing countries [1]. In such countries suffering from high prevalence of HBV, perinatal transmission from mothers to newborns serves as a major source of infection [2]. The World Health Organization (WHO) has recommended that the first dose of HBV vaccine be administered within 24 hours of birth [1]. Since implementing an additional dose of HBV vaccines within 24 hours of birth has become an important public health topic because the pentavalent vaccine delivered to infants can only be administered after six weeks, well after the perinatal period [1].
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