1 Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA.
2 Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, NY, USA.
Public Health Rep. 2018 May/Jun;133(3):338-346. doi: 10.1177/0033354918768224. Epub 2018 Apr 17.
Infants born to mothers who are hepatitis B surface antigen (HBsAg) positive are at risk for perinatal hepatitis B infection. As prevention, these infants receive a series of 3 or 4 doses of hepatitis B vaccine starting at birth and postvaccination serologic testing. Infants with antibody levels <10 mIU/mL are considered vaccine nonresponders and should be revaccinated. The objective of this cost analysis was to assess a single-dose revaccination strategy among infant nonresponders.
We used a decision analytic tree to compare the costs of a single-dose revaccination strategy with the costs of a 3-dose revaccination strategy. The analysis consisted of 3 epidemiologic scenarios that varied levels of previous protection among infants indicated for revaccination. We assumed health outcomes in each strategy were the same, and we evaluated costs from the societal perspective using 2016 US dollars. We conducted sensitivity analyses on key variables, including the minimum required efficacy of a single revaccination dose.
In all analyses, the single-dose revaccination strategy was a lower-cost option than the 3-dose revaccination strategy. Under the assumption that all revaccination visits were previously unscheduled, single-dose revaccination reduced the cost per infant by $119.81 to $155.72 (depending on the scenario). Across all scenarios, the most conservative estimate for the threshold efficacy (the minimum efficacy required to result in a lower-cost option) value of single-dose revaccination was 67%.
For infants who were born to HBsAg-positive mothers and who were not responding to the initial vaccine series, a single-dose revaccination strategy, compared with a 3-dose revaccination strategy, reduced costs across several scenarios. These results helped inform the Advisory Committee on Immunization Practices' vote in February 2017 to recommend single-dose revaccination.
母亲乙肝表面抗原（HBsAg）阳性的婴儿有感染围产期乙型肝炎的风险。作为预防措施，这些婴儿从出生开始接受 3 或 4 剂乙肝疫苗，并在接种疫苗后进行血清学检测。抗体水平<10 mIU/mL 的婴儿被认为是疫苗无应答者，应重新接种疫苗。本成本分析的目的是评估婴儿无应答者的单剂再接种策略。
我们使用决策树分析比较了单剂再接种策略与 3 剂再接种策略的成本。该分析包括 3 种流行病学情况，即需要重新接种疫苗的婴儿的先前保护水平各不相同。我们假设每种策略的健康结果相同，并从 2016 年的社会角度评估了成本。我们对关键变量进行了敏感性分析，包括单剂再接种所需的最低功效。
在所有分析中，单剂再接种策略是成本较低的选择，比 3 剂再接种策略低。在所有重新接种访问均为先前未安排的假设下，单剂再接种使每个婴儿的成本降低了 119.81 美元至 155.72 美元（取决于情况）。在所有情况下，单剂再接种的最低阈值功效（即导致成本较低的选择所需的最低功效）的最保守估计值为 67%。
对于出生于 HBsAg 阳性母亲且对初始疫苗系列无反应的婴儿，与 3 剂再接种策略相比，单剂再接种策略在几种情况下均降低了成本。这些结果有助于为免疫实践咨询委员会在 2017 年 2 月投票决定推荐单剂再接种提供信息。
