Abstract
The controlled temperature chain (CTC) strategy allows vaccines to be kept outside the cold chain for a short period of time. In remote rural areas, the CTC strategy for the hepatitis B virus (HBV) birth dose vaccination could improve its geographical coverage and timeliness of delivery, but with additional outreach costs. We assessed the cost-effectiveness of the CTC strategy for the HBV birth dose across six world regions and 72 countries according to their HBV prevalence, delivery costs, and birth dose coverage and timing. By use of a mathematical model of perinatal HBV transmission and disease progression, we calculated per 1000 births the total HBV-related disability-adjusted life-years (DALYs) and costs, including vaccine delivery costs and costs associated with HBV-related disease, with and without the CTC strategy. A CTC strategy produced health benefits in all regions and was cost-saving in the regions of east Asia and Pacific, Latin America and Caribbean, sub-Saharan Africa, and north Africa and Middle East. The CTC strategy cost US$0·15 (IQR -7·11 to 4·75) per DALY averted in the central and eastern Europe and central Asia region and $79·72 (66·47 to 94·47) in the south Asia region. Within individual countries, more savings were achieved and more DALYs averted in areas with above average HBV prevalence, below average birth dose coverage, or later than average birth dose delivery. A CTC outreach strategy that improves the timing and coverage of the HBV birth dose vaccination is likely to be cost-saving and reduce the burden of HBV infection associated with perinatal transmission. Burnet Institute.
Highlights
By use of a mathematical model of perinatal hepatitis B virus (HBV) transmission and disease progression, we calculated per 1000 births the total HBV-related disability-adjusted life-years (DALYs) and costs, including vaccine delivery costs and costs associated with HBV-related disease, with and without the controlled temperature chain (CTC) strateg
We considered six world regions according to the Global Burden of Disease (GBD) classifications[12] and 72 countries where data were available, accounting for differences in HBV prevalence and existing vaccine timing and coverages
The CTC strategy was cost-saving in the regions of east Asia and Pacific, Latin America and Caribbean ($890 [430–1490] per 1000 births), north Africa and Middle East ($1500 [1100–1920] per 1000 births), and sub-Saharan Africa ($1920 [1540–2140] per 1000 births), www.thelancet.com/lancetgh Vol 6 June 2018
Summary
Our aim was to provide evidence for the prioritisation of relicensing of the HBV vaccine under CTC conditions, rather than to quantify the costs saved by the governments
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