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Hepatitis B immunization in a low-incidence province of Canada: comparing alternative strategies
T Wiebe1, P Fergusson, D Horne
1Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
Insights
Universal infant immunization for hepatitis B virus (HBV) is cost-effective, costing $15,900 per year of life saved. This approach is economically practical for regions with low and stable HBV infection rates.
Area of Science:
- Public Health
- Health Economics
- Infectious Disease Epidemiology
Background:
- Hepatitis B virus (HBV) infection poses a significant global health burden.
- Effective immunization strategies are crucial for controlling HBV transmission and long-term health consequences.
- Previous analyses may not fully capture the long-term economic impact of different HBV immunization program designs.
Purpose of the Study:
- To conduct a comparative cost-effectiveness analysis of universal immunization programs for hepatitis B virus (HBV).
- To evaluate three theoretical cohorts: infants, 10-year-olds, and 12-year-olds, against a prenatal screening/newborn immunization program.
- To determine the most economically viable strategy for HBV prevention from a third-party payer perspective.
Main Methods:
- A Markov long-term outcome model was developed using Manitoba data to estimate costs and health outcomes across the lifespan.
- The model incorporated an HBV incidence rate of 19/100,000, a 5% discount rate, and recent treatment advances like interferon therapy.
- Cost-effectiveness was calculated as the ratio of Canadian dollars spent per year of life saved.
Main Results:
- The universal infant immunization program demonstrated a cost-effectiveness ratio of $15,900 (Canadian) per year of life saved.
- This ratio was substantially lower than those for universal programs targeting 10-year-olds ($97,600) and 12-year-olds ($184,800).
- Cost-effectiveness was sensitive to immunization costs, HBV incidence, and antibody level decay rates.
Conclusions:
- Universal infant immunization for HBV is an economically attractive and practical strategy, particularly in regions with low and stable HBV infection rates.
- Current trends suggest an increasing economic appeal for universal HBV immunization programs in the future.
- Optimizing immunization schedules and considering long-term economic impacts are vital for effective public health interventions against HBV.
Abstract:
This study provides a comparative cost-effectiveness analysis of three universal immunization programs for hepatitis B virus (HBV). Using three theoretical cohorts of infants, 10-year-olds, and 12-year-olds, a universal immunization program was compared with a prenatal screening/newborn immunization program involving testing of prepartum women and immunization of newborns of HBsAg-positive mothers. A Markov long-term outcome model used Manitoba data to estimate costs and health outcomes across the lifespan. The model was based on an HBV incidence rate of 19/100,000 and a discount rate of 5% and incorporated the most recent treatment advances (interferon therapy). Cost-effectiveness was calculated as the ratio of dollars spent per year of life saved, with costs determined from the perspective of a third-party payer. The universal infant-immunization program, although not cost-saving, was associated with a low, economically attractive cost-effectiveness ratio of $15,900 (Canadian) per year of life saved, a figure substantially lower than the ratios of $97,600 and $184,800 (Canadian) associated with the universal programs for 10- and 12-year-olds, respectively. Cost-effectiveness ratios were found to be sensitive to changes in immunization costs, HBV incidence rates, and the rate at which protective antibody levels are lost over time: If these variables move in the directions suggested by current trends, the authors anticipate an increasing economic appeal of universal programs well into the future. A universal program of HBV immunization for infants appears to be economically practical in regions where HBV infection rates are low and stable.