Wang Fengge, Zhou Lu, Lu Yihan
Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China.
Department of Epidemiology, Ministry of Education Key Laboratory of Public Health Safety, School of Public Health, Fudan University, Shanghai, China.
Transbound Emerg Dis. 2025 Mar 10;2025:9371055. doi: 10.1155/tbed/9371055. eCollection 2025.
Hepatitis E virus (HEV) is endemic in China, with swine as the most common reservoir. It poses a zoonotic public health risk to swine workers. This study evaluated the cost-effectiveness of hepatitis E vaccination for this high-risk group in China. A decision tree-Markov model was utilized to evaluate the cost-effectiveness of two hepatitis E vaccination strategies, without or following screening, for swine workers aged 16-60 in China from societal perspectives, compared to no vaccination. We calculated HEV-related cases and deaths averted, quality-adjusted life years (QALYs) gained, and incremental cost-effectiveness ratios (ICERs) with a willingness-to-pay (WTP) threshold of GDP per capita. A sensitivity analysis was conducted. Additionally, we stimulated the scenarios of fully receiving 3-dose schedule, partially receiving 3-dose schedule, and fully receiving 2-dose schedule. Both hepatitis E vaccination strategies significantly reduced HEV-related cases and deaths compared to no vaccination. ICERs were estimated to be USD 11,428.16 and 9830.71/QALY averted for vaccination without and following screening, respectively, both lower than GDP per capita (USD 12,325.24, 2023). Furthermore, one-way sensitivity analysis identified the discount rate, utility in asymptomatic cases, and probability of symptomatic infection as crucial factors affecting ICER. Probabilistic sensitivity analysis (PSA) showed a 47.5% cost-effectiveness probability for hepatitis E vaccination following screening, compared to 52.5% for no vaccination. Notably, vaccination following screening was cost-ineffective after age 40 and at a price of USD 138.0/dose. Additionally, fully receiving 2-dose and partially 3-dose schedules were cost-effective, regardless of hepatitis E vaccination without or following screening strategies, while fully receiving 3-dose schedule was cost-ineffective with the vaccination without screening strategy. Hepatitis E vaccination following screening would be optimal for swine workers in China. Vaccination starting at an earlier age and lower vaccine prices can improve the cost-effectiveness. Additionally, 2-dose schedule may be recommended during a hepatitis E outbreak to achieve cost-effectiveness.
戊型肝炎病毒（HEV）在中国呈地方性流行，猪是最常见的宿主。它对养猪工人构成人畜共患的公共卫生风险。本研究评估了中国这一高危人群接种戊型肝炎疫苗的成本效益。利用决策树-马尔可夫模型，从社会角度评估了两种戊型肝炎疫苗接种策略（不筛查或筛查后接种）对中国16至60岁养猪工人的成本效益，并与不接种疫苗进行了比较。我们计算了避免的戊型肝炎相关病例和死亡人数、获得的质量调整生命年（QALY）以及增量成本效益比（ICER），支付意愿（WTP）阈值为人均国内生产总值。进行了敏感性分析。此外，我们模拟了全程接种3剂次、部分接种3剂次和全程接种2剂次的情况。与不接种疫苗相比，两种戊型肝炎疫苗接种策略均显著降低了戊型肝炎相关病例和死亡人数。估计不筛查接种和筛查后接种的ICER分别为每避免一个QALY 11428.16美元和9830.71美元，均低于人均国内生产总值（分别为12325.24美元，2023年）。此外，单向敏感性分析确定贴现率、无症状病例的效用以及有症状感染的概率是影响ICER的关键因素。概率敏感性分析（PSA）显示，筛查后接种戊型肝炎疫苗的成本效益概率为47.5%，不接种疫苗的概率为52.5%。值得注意的是，40岁以后且疫苗价格为每剂138.0美元时，筛查后接种疫苗不具有成本效益。此外，无论不筛查或筛查后接种戊型肝炎疫苗策略，全程接种2剂次和部分接种3剂次均具有成本效益，而不筛查接种策略下全程接种3剂次不具有成本效益。在中国，筛查后接种戊型肝炎疫苗对养猪工人来说是最佳选择。尽早接种疫苗和降低疫苗价格可以提高成本效益。此外，在戊型肝炎疫情期间，可能建议采用2剂次接种方案以实现成本效益。
