National and provincial impact and cost-effectiveness of Haemophilus influenzae type b conjugate vaccine in China: a modeling analysis,BMC Medicine

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National and provincial impact and cost-effectiveness of Haemophilus influenzae type b conjugate vaccine in China: a modeling analysis
BMC Medicine ( IF 9.3 ) Pub Date : 2021-08-11 , DOI: 10.1186/s12916-021-02049-7
Haijun Zhang _{1,

2} , Cristina Garcia _{3,

4} , Wenzhou Yu ₅ , Maria Deloria Knoll _{3,

4} , Xiaozhen Lai _{1,

2} , Tingting Xu ₆ , Rize Jing _{1,

2} , Ying Qin ₇ , Zundong Yin ₅ , Brian Wahl _{3,

4} , Hai Fang _{1,

8,

9}

Affiliation

China Center for Health Development Studies, Peking University, Beijing, China.
Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China.
Department of Health Management and Policy, School of Public Health, Capital Medical University, Beijing, China.
Division of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China.
Peking University Health Science Center, Chinese Center for Disease Control and Prevention Joint Research Center for Vaccine Economics, Beijing, China.
Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Beijing, China.

Globally, Haemophilus influenzae type b (Hib) vaccine has substantially reduced the burden of Hib invasive disease. However, China remains the only country not to include Hib vaccine into its national immunization program (NIP), although it accounts for 11% of global Hib deaths. We aimed to assess the cost-effectiveness of including Hib vaccine in China’s NIP at the national and provincial levels. Using a decision-tree Markov state transition model, we estimated the cost-effectiveness of Hib vaccine in the NIP compared to the status quo of Hib vaccine in the private market for the 2017 birth cohort. Treatment costs and vaccine program costs were calculated from Chinese Center for Disease Control and Prevention (CDC) and national insurance databases. Epidemiological data and other model parameters were obtained from published literature. Cases and deaths averted, quality-adjusted life years (QALYs) gained, and incremental cost-effectiveness ratios (ICER) were predicted by province. Deterministic and probabilistic sensitivity analyses were performed to explore model uncertainty. Including Hib vaccine in the NIP was projected to prevent approximately 2700 deaths (93% reduction) and 235,700 cases of Hib disease (92% reduction) for the 2017 birth cohort at the national level. Hib vaccine was cost-effective nationally (US$ 8001 per QALY gained) compared to the GDP per capita and cost-effective in 15 of 31 provinces. One-way and scenario sensitivity analyses indicated results were robust when varying model parameters, and in probabilistic sensitivity analysis, Hib vaccine had a 64% probability of being cost-effective nationally. Introducing Hib vaccine in China’s NIP is cost-effective nationally and in many provinces. Less socioeconomically developed provinces with high Hib disease burden and low access to Hib vaccine in the current private market, such as those in the west region, would benefit the most from adding Hib vaccine to the NIP. In the absence of a national policy decision on Hib vaccine, this analysis provides evidence for provincial governments to include Hib vaccine into local immunization programs to substantially reduce disease burden and treatment costs.

更新日期：2021-08-11

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