Cost-effectiveness and affordability of strategy for preventing mother-to-child transmission of hepatitis B in China / 中华流行病学杂志

ABSTRACT

Objective To evaluate the cost effectiveness of nationwide prevention of mother to child transmission (PMTCT) strategy for hepatitis B,and estimate the willing to pay and budget impacts on the PMTCT.Methods The decision analytic Markov model for the PMTCT was constructed and a birth cohort of Chinese infants born in 2013 was used to calculate the cost-effectiveness of the PMTCT among them compared with those receiving no intervention.The parameters in the model were obtained from literatures of national surveys or Meta-analysis.The costs,cases of HBV-related diseases and quality-adjusted life-years (QALYs) were obtained from the societal and payer perspectives,respectively.The incremental cost-effectiveness ratio (ICER) was used as measures of strategy optimization.One-way and probability sensitivity analysis were performed to explore the uncertainty of the primary results.In addition,cost-effectiveness acceptability curve and cost-effectiveness affordability curves were drawn to illustrate the cost effectiveness threshold and financial budget of the PMTCT strategy.Results The lifetime cost for PMTCT strategy was 4 063.5 yuan (RMB) per carrier,which was 37 829.7 yuan (RMB) lower compared with those receiving no intervention.Due to the strategy,a total of 24.516 1 QALYs per person would be gained,which was higher than that in those receiving no intervention.From societal perspective,the ICER was-59 136.6yuan (RMB) per additional QALYs gained,indicating that the PMTCT is cost effective.The results were reliable indicated by one-way,multi-way and probability sensitivity analyses.By the CEAC,the willing to pay was much lower than the cost-effectiveness threshold.From the affordability curve of the PMTCT strategy,the annual budget ranged from 590.4 million yuan (RMB) to 688.8 million yuan (RMB),which was lower than the financial ability.Based on the results of cost-effectiveness affordability curves,the higher annual budget was determined,the higher probability of affordability for the PMTCT would be obtained under the same willing to pay state.Only when the annual budget reaches 688.8 million yuan (RMB),the goal of PMTCT would be fully realized.Conclusions The PMTCT strategy in China was cost effective,and the cost is not beyond the financial budget needed and the willing to pay.The strategy,which is consistent with the global hepatitis B elimination efforts,should be conducted widely in China.