{"title":"Cost-Effectiveness Analysis of Hepatitis E Vaccination Strategies for Swine Workers","authors":"Fengge Wang, Lu Zhou, Yihan Lu","doi":"10.1155/tbed/9371055","DOIUrl":null,"url":null,"abstract":"<div>\n <p>Hepatitis E virus (HEV) is endemic in China, with swine as the most common reservoir. It poses a zoonotic public health risk to swine workers. This study evaluated the cost-effectiveness of hepatitis E vaccination for this high-risk group in China. A decision tree-Markov model was utilized to evaluate the cost-effectiveness of two hepatitis E vaccination strategies, without or following screening, for swine workers aged 16–60 in China from societal perspectives, compared to no vaccination. We calculated HEV-related cases and deaths averted, quality-adjusted life years (QALYs) gained, and incremental cost-effectiveness ratios (ICERs) with a willingness-to-pay (WTP) threshold of GDP per capita. A sensitivity analysis was conducted. Additionally, we stimulated the scenarios of fully receiving 3-dose schedule, partially receiving 3-dose schedule, and fully receiving 2-dose schedule. Both hepatitis E vaccination strategies significantly reduced HEV-related cases and deaths compared to no vaccination. ICERs were estimated to be USD 11,428.16 and 9830.71/QALY averted for vaccination without and following screening, respectively, both lower than GDP per capita (USD 12,325.24, 2023). Furthermore, one-way sensitivity analysis identified the discount rate, utility in asymptomatic cases, and probability of symptomatic infection as crucial factors affecting ICER. Probabilistic sensitivity analysis (PSA) showed a 47.5% cost-effectiveness probability for hepatitis E vaccination following screening, compared to 52.5% for no vaccination. Notably, vaccination following screening was cost-ineffective after age 40 and at a price of USD 138.0/dose. Additionally, fully receiving 2-dose and partially 3-dose schedules were cost-effective, regardless of hepatitis E vaccination without or following screening strategies, while fully receiving 3-dose schedule was cost-ineffective with the vaccination without screening strategy. Hepatitis E vaccination following screening would be optimal for swine workers in China. Vaccination starting at an earlier age and lower vaccine prices can improve the cost-effectiveness. Additionally, 2-dose schedule may be recommended during a hepatitis E outbreak to achieve cost-effectiveness.</p>\n </div>","PeriodicalId":234,"journal":{"name":"Transboundary and Emerging Diseases","volume":"2025 1","pages":""},"PeriodicalIF":3.5000,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/tbed/9371055","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Transboundary and Emerging Diseases","FirstCategoryId":"97","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1155/tbed/9371055","RegionNum":2,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
引用次数: 0
Abstract
Hepatitis E virus (HEV) is endemic in China, with swine as the most common reservoir. It poses a zoonotic public health risk to swine workers. This study evaluated the cost-effectiveness of hepatitis E vaccination for this high-risk group in China. A decision tree-Markov model was utilized to evaluate the cost-effectiveness of two hepatitis E vaccination strategies, without or following screening, for swine workers aged 16–60 in China from societal perspectives, compared to no vaccination. We calculated HEV-related cases and deaths averted, quality-adjusted life years (QALYs) gained, and incremental cost-effectiveness ratios (ICERs) with a willingness-to-pay (WTP) threshold of GDP per capita. A sensitivity analysis was conducted. Additionally, we stimulated the scenarios of fully receiving 3-dose schedule, partially receiving 3-dose schedule, and fully receiving 2-dose schedule. Both hepatitis E vaccination strategies significantly reduced HEV-related cases and deaths compared to no vaccination. ICERs were estimated to be USD 11,428.16 and 9830.71/QALY averted for vaccination without and following screening, respectively, both lower than GDP per capita (USD 12,325.24, 2023). Furthermore, one-way sensitivity analysis identified the discount rate, utility in asymptomatic cases, and probability of symptomatic infection as crucial factors affecting ICER. Probabilistic sensitivity analysis (PSA) showed a 47.5% cost-effectiveness probability for hepatitis E vaccination following screening, compared to 52.5% for no vaccination. Notably, vaccination following screening was cost-ineffective after age 40 and at a price of USD 138.0/dose. Additionally, fully receiving 2-dose and partially 3-dose schedules were cost-effective, regardless of hepatitis E vaccination without or following screening strategies, while fully receiving 3-dose schedule was cost-ineffective with the vaccination without screening strategy. Hepatitis E vaccination following screening would be optimal for swine workers in China. Vaccination starting at an earlier age and lower vaccine prices can improve the cost-effectiveness. Additionally, 2-dose schedule may be recommended during a hepatitis E outbreak to achieve cost-effectiveness.
期刊介绍：
Transboundary and Emerging Diseases brings together in one place the latest research on infectious diseases considered to hold the greatest economic threat to animals and humans worldwide. The journal provides a venue for global research on their diagnosis, prevention and management, and for papers on public health, pathogenesis, epidemiology, statistical modeling, diagnostics, biosecurity issues, genomics, vaccine development and rapid communication of new outbreaks. Papers should include timely research approaches using state-of-the-art technologies. The editors encourage papers adopting a science-based approach on socio-economic and environmental factors influencing the management of the bio-security threat posed by these diseases, including risk analysis and disease spread modeling. Preference will be given to communications focusing on novel science-based approaches to controlling transboundary and emerging diseases. The following topics are generally considered out-of-scope, but decisions are made on a case-by-case basis (for example, studies on cryptic wildlife populations, and those on potential species extinctions):
Pathogen discovery: a common pathogen newly recognised in a specific country, or a new pathogen or genetic sequence for which there is little context about — or insights regarding — its emergence or spread.
Prevalence estimation surveys and risk factor studies based on survey (rather than longitudinal) methodology, except when such studies are unique. Surveys of knowledge, attitudes and practices are within scope.
Diagnostic test development if not accompanied by robust sensitivity and specificity estimation from field studies.
Studies focused only on laboratory methods in which relevance to disease emergence and spread is not obvious or can not be inferred (“pure research” type studies).
Narrative literature reviews which do not generate new knowledge. Systematic and scoping reviews, and meta-analyses are within scope.
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