Memirie Solomon Tessema, Desalegn Hailemichael, Naizgi Mulugeta, Nigus Mulat, Taddesse Lisanu, Tadesse Yared, Tessema Fasil, Zelalem Meseret, Girma Tsinuel
Department of Pediatrics and Child Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
Cost Eff Resour Alloc. 2020 Jul 22;18:23. doi: 10.1186/s12962-020-00219-7. eCollection 2020.
Hepatitis B virus (HBV) infection is an important cause of morbidity and mortality with a very high burden in Africa. The risk of developing chronic infection is marked if the infection is acquired perinatally, which is largely preventable through a birth dose of HBV vaccine. We examined the cost-effectiveness of a birth dose of HBV vaccine in a medical setting in Ethiopia.
We constructed a decision analytic model with a Markov process to estimate the costs and effects of a birth dose of HBV vaccine (the intervention), compared with current practices in Ethiopia. Current practice is pentavalent vaccination (DPT-HiB-HepB) administered at 6, 10 and 14 weeks after birth. We used disability-adjusted life years (DALYs) averted to quantify the health benefits while the costs of the intervention were expressed in 2018 USD. Analyses were based on Ethiopian epidemiological, demographic and cost data when available; otherwise we used a thorough literature review, in particular for assigning transition probabilities.
In Ethiopia, where the prevalence of HBV among pregnant women is 5%, adding a birth dose of HBV vaccine would present an incremental cost-effectiveness ratio (ICER) of USD 110 per DALY averted. The estimated ICER compares very favorably with a willingness-to-pay level of 0.31 times gross domestic product per capita (about USD 240 in 2018) in Ethiopia. Our ICER estimates were robust over a wide range of epidemiologic, vaccine effectiveness, vaccine coverage and cost parameter inputs.
Based on our cost-effectiveness findings, introducing a birth dose of HBV vaccine in Ethiopia would likely be highly cost-effective. Such evidence could help guide policymakers in considering including HBV vaccine into Ethiopia's essential health services package.
乙型肝炎病毒（HBV）感染是发病和死亡的重要原因，在非洲负担极高。如果围产期感染HBV，发展为慢性感染的风险很大，而通过一剂乙肝疫苗在很大程度上可预防这种情况。我们在埃塞俄比亚的一个医疗环境中研究了一剂乙肝疫苗的成本效益。
我们构建了一个带有马尔可夫过程的决策分析模型，以估计一剂乙肝疫苗（干预措施）的成本和效果，并与埃塞俄比亚的现行做法进行比较。现行做法是在出生后6周、10周和14周接种五价疫苗（白百破- Hib-乙肝）。我们用避免的伤残调整生命年（DALYs）来量化健康效益，而干预措施的成本以2018年美元表示。分析基于埃塞俄比亚现有的流行病学、人口统计学和成本数据；否则我们进行全面的文献综述，特别是用于确定转移概率。
在埃塞俄比亚，孕妇中HBV流行率为5%，增加一剂乙肝疫苗的增量成本效益比（ICER）为每避免一个DALY 110美元。估计的ICER与埃塞俄比亚人均国内生产总值0.31倍的支付意愿水平（2018年约240美元）相比非常有利。我们的ICER估计在广泛的流行病学、疫苗效力、疫苗覆盖率和成本参数输入范围内都很稳健。
基于我们的成本效益研究结果，在埃塞俄比亚引入一剂乙肝疫苗可能具有很高的成本效益。这些证据可帮助指导政策制定者考虑将乙肝疫苗纳入埃塞俄比亚基本卫生服务包。
