Cost-Effectiveness Analysis of Hepatitis E Vaccination Strategies for Swine Workers

Hepatitis E virus (HEV) is endemic in China, with swine as the most common reservoir. It poses a zoonotic public health risk to swine workers. This study evaluated the cost-effectiveness of hepatitis E vaccination for this high-risk group in China. A decision tree-Markov model was utilized to evaluate the cost-effectiveness of two hepatitis E vaccination strategies, without or following screening, for swine workers aged 16-60 in China from societal perspectives, compared to no vaccination. We calculated HEV-related cases and deaths averted, quality-adjusted life years (QALYs) gained, and incremental cost-effectiveness ratios (ICERs) with a willingness-to-pay (WTP) threshold of GDP per capita. A sensitivity analysis was conducted. Additionally, we stimulated the scenarios of fully receiving 3-dose schedule, partially receiving 3-dose schedule, and fully receiving 2-dose schedule. Both hepatitis E vaccination strategies significantly reduced HEV-related cases and deaths compared to no vaccination. ICERs were estimated to be USD 11,428.16 and 9830.71/QALY averted for vaccination without and following screening, respectively, both lower than GDP per capita (USD 12,325.24, 2023). Furthermore, one-way sensitivity analysis identified the discount rate, utility in asymptomatic cases, and probability of symptomatic infection as crucial factors affecting ICER. Probabilistic sensitivity analysis (PSA) showed a 47.5% cost-effectiveness probability for hepatitis E vaccination following screening, compared to 52.5% for no vaccination. Notably, vaccination following screening was cost-ineffective after age 40 and at a price of USD 138.0/dose. Additionally, fully receiving 2-dose and partially 3-dose schedules were cost-effective, regardless of hepatitis E vaccination without or following screening strategies, while fully receiving 3-dose schedule was cost-ineffective with the vaccination without screening strategy. Hepatitis E vaccination following screening would be optimal for swine workers in China. Vaccination starting at an earlier age and lower vaccine prices can improve the cost-effectiveness. Additionally, 2-dose schedule may be recommended during a hepatitis E outbreak to achieve cost-effectiveness.