London School of Economics and Political Science, London WC2A 2AE, United Kingdom.
Vaccine. 2012 Dec 17;31(1):252-9. doi: 10.1016/j.vaccine.2012.08.007. Epub 2012 Aug 15.
This study is the first to assess the cost-effectiveness of an additional birth dose of Hepatitis B (HBV) vaccine administered by professional birth attendants in medical settings in a sub-Saharan country (Mozambique). The WHO has recommended the birth dose to prevent perinatal transmission of HBV. A Markov model was constructed to analyse the costs and effects associated with avoiding perinatal transmission of HBV through a birth dose vaccination in addition to the existing vaccination schedule in Mozambique. The comparator intervention is the existing vaccination schedule administered at 6-10-14 weeks. The analysis was conducted for the birth cohort of 2008. As the context is a low-income setting our main outcome measure was disability-adjusted life years (DALYs) averted. Transition probabilities, costs and effects were estimated based on a thorough literature review. One- to three-way sensitivity analyses were conducted to account for uncertainty in the data. We found an incremental cost-effectiveness ratio (ICER) for the additional birth dose of 250.95 US$ per DALY averted. Assuming a willingness-to-pay threshold of 441 US$, which was the GDP per capita for Mozambique in 2008, the findings show the additional birth dose to be highly cost-effective. However, one-way sensitivity analysis reveals that the outcome changes with parameter variation. To give unambiguous recommendations on introducing the birth dose in Mozambique, more information on the parameters that render the birth dose cost-ineffective in sensitivity analysis is needed. Those parameters are 'vaccine effectiveness', 'prevalence of HBV among mothers', 'the transition probability from chronic HBV to liver cancer' and 'the risk of perinatal transmission for mothers negative for the Hepatitis B "e" antigen (HBeAg)'. Parameter variation (one-way) showed the ICER to lie between 72 US$/DALY averted and 683 US$/DALY averted.
这项研究首次评估了在撒哈拉以南国家（莫桑比克）的医疗环境中，由专业接生员额外接种一剂乙型肝炎（HBV）疫苗的成本效益。世界卫生组织（WHO）建议在出生时接种一剂乙肝疫苗，以预防母婴传播HBV。研究构建了一个马尔可夫模型，分析了在莫桑比克现有的疫苗接种计划之外，通过出生时接种一剂乙肝疫苗来避免母婴传播 HBV 所涉及的成本和效果。比较干预措施是在 6-10-14 周时接种的现有疫苗接种计划。该分析是针对 2008 年出生的队列进行的。由于该环境是低收入环境，我们的主要结果衡量标准是避免残疾调整生命年（DALY）。基于全面的文献回顾，对转移概率、成本和效果进行了估计。进行了一到三种敏感性分析，以考虑数据中的不确定性。我们发现，额外接种一剂乙肝疫苗的增量成本效益比（ICER）为每避免一个 DALY 需花费 250.95 美元。假设一个支付意愿阈值为 441 美元，这是 2008 年莫桑比克的人均国内生产总值，研究结果表明，额外接种一剂乙肝疫苗的成本效益极高。然而，单向敏感性分析表明，结果会随着参数的变化而变化。为了在莫桑比克明确推荐引入该疫苗，需要更多关于使出生时接种疫苗在敏感性分析中变得无成本效益的参数的信息。这些参数是“疫苗效力”、“母亲中 HBV 的流行率”、“从慢性 HBV 到肝癌的转移概率”和“乙型肝炎 e 抗原（HBeAg）阴性母亲的母婴传播风险”。参数变化（单向）显示，ICER 在每避免一个 DALY 72 美元至 683 美元之间。
