Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 31, Issue 14, Pages 1765-1878 (3 April 2013)

Economic evaluation of universal newborn hepatitis B vaccination in China
Original Research Article
Pages 1864-1869
Sandy Qiuying Lu, Sarah M. McGhee, Xu Xie, Jinquan Cheng, Richard Fielding

Abstract
Objective
To estimate the long-term cost-effectiveness of universal newborn hepatitis B vaccination in China, an area of high endemicity.

Method
A decision tree was used to describe perinatal hepatitis B virus (HBV) transmission, early infection and impact of vaccination. A Markov model based on 1-year cycles was used to simulate these impacts for the lifetime of a cohort of 10,000,000 infants born in 2002 in China. We compared both cost and health outcomes for two strategies: universal newborn vaccination comprising a timely birth dose (HepB1) with a three-dose vaccination (HepB3) compared with no vaccination. Univariate and probabilistic sensitivity analyses using Monte Carlo simulations were performed to test parameter uncertainty.

Results
Over the cohort’s lifetime, 79,966 chronic infections, 37,553 cases of hepatocellular carcinoma (HCC) and 130,796 HBV related deaths would be prevented by universal infant vaccination. The prevalence of HBV infection is reduced by 76%. Over 743,000 life-years and 620,000 quality adjusted life years (QALYs) would be gained and there would be monetary benefits of more than 1 billion US dollars in medical care costs and lost productivity avoided.

Conclusion
The newborn vaccination programme for Hepatitis B in China both gains QALYs and saves medical care costs. It is important to ensure that timely and comprehensive vaccination programmes continue.