Chinese health officials were considering a program of catch-up vaccinations for children who had not been vaccinated at birth, but were reluctant to commit funds to a widespread hepatitis B catch-up vaccination program until analysis confirmed its cost-effectiveness.
The Institute for Operations Research and the Management Sciences (INFORMS) determined that it would be cost effective to expand free catch-up vaccination to all children in China under the age of 15. China began implementation of the catch up vaccinations in 2009.
This decision could result in almost 170 million children being vaccinated and could prevent almost 8 million acute infections, 400,000 chronic infections, and almost 70,000 deaths. The vaccinations would cost the equivalent of $540 million and save the equivalent of $1.4 billion over the lifetime of these children, for a net present savings of approximately $900 million.
Additionally, they would spare hundreds of thousands of Chinese children from facing a lifetime of discrimination – those infected with hepatitis B in China, according to reports, are often denied the right to attend school or enter the workplace.
In the U.S., they evaluated four clinical strategies. Of the four, they concluded that it is most cost-effective to adopt a strategy of screening adult Asian and Pacific Islanders for chronic hepatitis B infection so that those identified can receive treatment. They also found it cost-effective to vaccinate those in close contact with the infected so they can be protected from contagion.
Using a common public health metric, they estimate that it costs $36,000–$40,000 per quality-adjusted life year (QALY) gained to screen and provide treatment for adult Asian and Pacific Islanders. In the U.S., an intervention that costs less than $50,000 per QALY gained is generally considered to be cost effective.
The total cost of treating chronically infected people in the U.S. is more than 100 times greater than the cost of the initial screening program.
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