Impact and Cost-Effectiveness of National Hepatitis B Immunization Program in China

Background: Chinese government launched national Hepatitis B immunization program since 1992. We aimed to evaluate the effects of neonatal hepatitis B vaccine in China. Methods: In the mathematical model, nine compartments were expanded beyond a typical susceptible-exposed-infected-recovered (SEIR) model. While in the decision tree-Markov model, eight Markov states were included to simulate HBV infection and progression. The expected cost and impact were compared between neonatal hepatitis B vaccine strategy and non-vaccination, and the incremental cost-effectiveness ratio (ICER, additional cost per quality-adjusted life-years gained) was calculated. Various intervention scenarios were compared to evaluate the impact and cost-effectiveness of hepatitis B vaccination, which provides evidence for exploring new prevention and control strategies. Findings: This study estimated the chronic HBV infectious cases incurred from 1990 to 2018, and projected prevalence of the epidemic in the following 30 years. Compared with 1990, the real-time cumulative number of chronic HBV infectious cases decreased by 33·9% in 2018. Comparing status quo scenario and 2nd scenario, 3rd scenario and 4th scenario, the total number of chronic HBV infectious cases would reach to 119·5 million, 99·4 million and 82·7 million in 2020, respectively. The cost-effectiveness analysis shows that the implementation of the neonatal hepatitis B vaccine strategy can increase effectiveness by 1·77 QALYs per capita; and while each person obtains a unit of QALY, the cost for the whole society saves 56533·56 RMB. Interpretations: Our findings proved the effectiveness of the HBV vaccination in controlling the epidemic of hepatitis B after about 30 years of implementation of the national Hepatitis B immunization program. Although China has achieved a great deal in hepatitis B prevention, the overall burden of hepatitis B remains quite heavy. Therefore, more strategies need to be explored for controlling and eventually eliminating hepatitis B. Funding: This work was supported by the Evaluation project on national immunization program of China and Shanghai New Three-year Action Plan for Public Health (grant no. GWV-10.1-XK16). Declaration of Interest: We declare no competing interests.