Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia.
Lancet Glob Health. 2020 Jul;8(7):e931-e941. doi: 10.1016/S2214-109X(20)30231-X.
Hepatitis B causes more than 800 000 deaths globally each year. Perinatal infections are a major driver of this burden but can be prevented by vaccination within 24 h of birth. Currently, only 44% of newborn babies in low-income and middle-income countries (LMICs) receive a timely birth dose. We investigated the effects and cost-effectiveness of implementing ambient storage of hepatitis B vaccines under a controlled temperature chain (CTC) protocol and the use of compact prefilled auto-disable (CPAD) devices for community births.
In this mathematical modelling study of perinatal hepatitis B transmission and disease progression, we estimated the coverage impact and cost-effectiveness of implementing CTC and CPAD interventions in the six Global Burden of Disease (GBD) regions containing LMICs. Combinations of four different scenarios of birth dose delivery strategies (cold chain, CTC) and interventions (needle and syringe, CPAD) were modelled across facility or community birth locations. We also estimated the minimum cost and most cost-effective strategy to achieve the WHO 90% hepatitis B birth dose coverage target in GBD regions and in 46 LMICs with a reported coverage of less than 90%.
Current delivery protocols achieved a maximum coverage of 65% (IQR 64-65) across GBD regions. Reaching 90% hepatitis B birth dose coverage across all GBD regions was estimated to cost a minimum of US$687·5 million per annum ($494·0 million more than the estimated current expenditure), of which $516·5 million (75%) was required for CTC and CPAD interventions. Reaching 90% coverage in this way was estimated to be cost saving in five of the six regions (and in 40 of 46 LMICs individually assessed) due to the disease costs averted, with the cost per disability-adjusted life-years averted being less than $83·27 otherwise.
Hepatitis B birth dose coverage of 90% is unlikely to be reached under current protocols. CTC and CPAD vaccine strategies present cost-effective solutions to overcome coverage barriers.
The Burnet Institute.
乙型肝炎每年在全球导致超过 80 万人死亡。围产期感染是造成这一负担的主要原因，但可以通过在出生后 24 小时内接种疫苗来预防。目前，低收入和中等收入国家（LMICs）只有 44%的新生儿接受及时的出生剂量。我们调查了在控制温度链（CTC）协议下实施乙型肝炎疫苗环境储存和在社区分娩中使用紧凑型预充自动失效（CPAD）装置对围产期乙型肝炎传播和疾病进展的影响和成本效益。
在这项关于围产期乙型肝炎传播和疾病进展的数学模型研究中，我们估计了在包含 LMIC 的六个全球疾病负担（GBD）区域实施 CTC 和 CPAD 干预措施对覆盖范围的影响和成本效益。在设施或社区分娩地点，我们对四种不同的出生剂量递送策略（冷链、CTC）和干预措施（针和注射器、CPAD）组合进行了建模。我们还估计了实现 GBD 区域和报告覆盖率低于 90%的 46 个 LMIC 中世卫组织 90%乙型肝炎出生剂量覆盖率目标的最低成本和最具成本效益的策略。
目前的交付协议在 GBD 区域实现了 65%的最高覆盖率（IQR64-65）。估计要在所有 GBD 区域实现 90%的乙型肝炎出生剂量覆盖率，每年至少需要花费 6.875 亿美元（比估计的当前支出多出 4.94 亿美元），其中 5.165 亿美元（75%）用于 CTC 和 CPAD 干预措施。由于避免了疾病成本，在六个区域中的五个区域（以及单独评估的 46 个 LMIC 中的 40 个）中，以这种方式实现 90%的覆盖率估计是节省成本的，否则每避免一个残疾调整生命年的成本将低于 83.27 美元。
在目前的方案下，乙型肝炎出生剂量覆盖率达到 90%是不太可能的。CTC 和 CPAD 疫苗策略提供了具有成本效益的解决方案，可以克服覆盖范围的障碍。
伯内特研究所。
