Cost-effectiveness and cost-benefit analysis on strategy for preventing mother-to-child transmission of hepatitis B virus / 中华流行病学杂志

ABSTRACT

Objective Through cost-benefit analysis (CBA),cost-effectiveness analysis (CEA) and quantitative optimization analysis to understand the economic benefit and outcomes of strategy regarding preventing mother-to-child transmission (PMTCT) on hepatitis B virus.Methods Based on the principle of Hepatitis B immunization decision analytic-Markov model,strategies on PMTCT and universal vaccination were compared.Related parameters of Shenzhen were introduced to the model,a birth cohort was set up as the study population in 2013.The net present value (NPV),benefit-cost ratio (BCR),incremental cost-effectiveness ratio (ICER) were calculated and the differences between CBA and CEA were compared.Results A decision tree was built as the decision analysis model for hepatitis B immunization.Three kinds of Markov models were used to simulate the outcomes after the implementation of vaccination program.The PMTCT strategy of Shenzhen showed a net-gain as 38 097.51 Yuan/per person in 2013,with BCR as 14.37.The universal vaccination strategy showed a net-gain as 37 083.03 Yuan/per person,with BCR as 12.07.Data showed that the PMTCT strategy was better than the universal vaccination one and would end with gaining more economic benefit.When comparing with the universal vaccination program,the PMTCT strategy would save 85 100.00 Yuan more on QALY gains for every person.The PMTCT strategy seemed more cost-effective compared with the one under universal vaccination program.In the CBA and CEA hepatitis B immunization programs,the immunization coverage rate and costs of hepatitis B related diseases were the most important influencing factors.Outcomes of joint-changes of all the parameters in CEA showed that PMTCT strategy was a more cost-effective.Conclusions The PMTCT strategy gained more economic benefit and effects on health.However,the cost of PMTCT strategy was more than the universal vaccination program,thus it is important to pay attention to the process of PMTCT strategy and the universal vaccination program.CBA seemed suitable for strategy optimization while CEA was better for strategy evaluation.Hopefully,programs as combination of the above said two methods would facilitate the process of economic evaluation.