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ORIGINAL RESEARCH article
Front. Public Health
Sec. Health Economics
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1532604
Health economic evaluation of newborn hepatitis B immunization prevention strategies in Ningbo: a Markov modelling study
Provisionally accepted
Wei Feng 1
Zhengxiong Li 2
Mingkuan Fan 3
Sijia Yang 4 Yuqi Shao 1
Kui Liu 5*
Shuaishuai Huang 6* Sanjun Fu 1*- 1 Fenghua District Center for Disease Control and Prevention, Ningbo City, China
- 2 School of Medical Informatics and Engineering, Xuzhou Medical University, Xuzhou, China
- 3 School of Medicine, Xiangyang Polytechnic,, Xiangyang, China
- 4 Ningbo Municipal Center for Disease Control and Prevention, Ningbo, Zhejiang Province, China
- 5 Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
- 6 Yinzhou No.2 Hospital, Ningbo, Zhejiang Province, China
Background: Hepatitis B virus (HBV) infection poses a significant public health challenge in China.The Prevention of mother-to-child Transmission (PMTCT) strategy of combining universal hepatitis B vaccination with hepatitis B immunoglobulin (HBIG) for newborns is crucial in preventing widespread infection. In this study, we conduct health economic evaluation of three strategies: PMTCT, universal vaccination, and non-vaccination for newborns in Ningbo, China.Methods: This study developed a decision-Markov model and simulated a cohort of 100,000 newborns to assess the cost-effectiveness and cost-benefit of three strategies from a healthcare system perspective. The primary outputs included total costs, life-years (LYs), quality-adjusted lifeyears (QALYs), incremental cost-effectiveness ratios (ICERs), benefit-cost ratios (BCRs). One-way and probabilistic sensitivity analyses (PSA) were performed to verify the robustness of the model.Results: Among the three strategies, the PMTCT results in the least disease burden and mortality related to hepatitis B. In comparison to a cohort of 100,000 unvaccinated infants, the PMTCT is expected to prevent 6,029 cases of acute symptomatic infections, 27,348 HBV carriers, 4,170 chronic infections, 3,597 cases of cirrhosis, 2,911 cases of hepatocellular carcinoma (HCC), and 3,930 HBVrelated deaths. The ICERs for PMTCT and universal vaccination were -56,371.77 yuan/QALY and -56,654.77 yuan/QALY, respectively. The BCRs for PMTCT and universal vaccination were 19.13 and 15.95, respectively, when compared to no vaccination. The PSA revealed that all ICER scatter plots are situated within the fourth quadrant, and the probability of PMTCT being cost-effective exceeds 90%.Implementing universal hepatitis B vaccination with HBIG for newborns in Ningbo demonstrated high cost-effectiveness, making the continuation of the PMTCT strategy highly recommended.
Keywords: Hepatitis B, Vaccination, mother-to-child transmission, economic evaluation, Markov model
Received: 22 Nov 2024; Accepted: 27 Mar 2025.
Copyright: © 2025 Feng, Li, Fan, Yang, Shao, Liu, Huang and Fu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Kui Liu, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
Shuaishuai Huang, Yinzhou No.2 Hospital, Ningbo, Zhejiang Province, China
Sanjun Fu, Fenghua District Center for Disease Control and Prevention, Ningbo City, China
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