Assessing the cost-utility of universal hepatitis B vaccination among adults

BACKGROUND: Although effective against hepatitis B virus (HBV) infection, hepatitis B (HepB) vaccination is only recommended for infants, children and adults at higher risk. We conducted an economic evaluation of universal HepB vaccination among US adults.

METHODS: Using a decision analytic model with Markov disease progression, we compared current vaccination recommendations (baseline) with either 3-dose or 2-dose universal HepB vaccination (intervention strategies). In simulated modeling of one million adults distributed by age and risk groups, we quantified health benefits (quality-adjusted life years, QALYs) and costs for each strategy. Multivariable probabilistic sensitivity analyses identified key inputs. All costs reported in 2019 US dollars.

RESULTS: With incremental base-case vaccination coverage up to 50% among persons at lower risk and 0% increment among persons at higher risk, each of two intervention strategies averted nearly one quarter of acute HBV infections (3-dose strategy: 24.8%; 2-dose strategy: 24.6%). Societal incremental cost per QALY gained of $152,722 (Interquartile range: $119,113, $235,086) and $155,429 (Interquartile range: $120,302, $242,226) were estimated for 3-dose and 2-dose strategies, respectively. Risk of acute HBV infection showed the strongest influence.

CONCLUSIONS: Universal adult vaccination against HBV may be an appropriate strategy for reducing HBV incidence and improving resulting health outcomes.

Full citation:
Hall EW, Weng MK, Harris AM, Schillie S, Nelson NP, Ortega-Sanchez IR, Rosenthal E, Sullivan PS, Lopman B, Jones J, Bradley H, Rosenberg ES (2022).
Assessing the cost-utility of universal hepatitis B vaccination among adults
Journal of Infectious Diseases [Epub 2022 Mar 9]. doi: 10.1093/infdis/jiac088.