The doses of 10 μg should replace the doses of 5 μg in newborn hepatitis B vaccination in China: A cost-effectiveness analysis

Abstract

ObjectiveTo identify whether Chinese current series of three 5μg doses for newborn hepatitis B vaccination should be replaced by the series of three 10μg doses. MethodsA cost-effectiveness analysis was conducted from the societal perspective based on the constructed decision tree-Markov model. Model parameters were estimated from published literatures, government documents and our surveys. The expected cost and effectiveness were compared between the 3-dose 5μg series (the 5μg strategy) and the 3-dose 10μg series (the 10μg strategy), and the incremental cost-effectiveness ratio (ICER, additional cost per quality-adjusted life-years gained) was calculated. Threshold values of the efficacy difference of the two series for the ICER=0, 1 and 3 times per capita gross domestic product were analyzed under different scenarios to understand whether the 10μg strategy should replace the 5μg strategy according to the recommendation of World Health Organization. ResultsThe 10μg strategy would be cost-saving compared with the 5μg strategy under the base-case scenario. Under keeping all the other parameters at the base-case values or further adjusting any one of them to the value most unfavorable to the 10μg strategy, as long as the efficacy of 3-dose 10μg series was slightly higher than that of 3-dose 5μg series, the 10μg strategy would be cost-effective, highly cost-effective, or even cost-saving. Even under the most pessimistic scenario, i.e. all the other parameters, but the discount rate, at the values most unfavorable to the 10μg strategy, the 10μg strategy would be cost-effective if the efficacy difference reached higher than 1.23 percentage point. ConclusionFor newborn hepatitis B vaccination in China, the 10μg strategy should be cost-effective, even more possibly highly cost-effective or cost-saving compared with the current 5μg strategy. The doses of 10μg should be considered to replace the doses of 5μg in newborn hepatitis B vaccination in China.