Introduction of birth dose of hepatitis B virus vaccine to the immunization program in Ethiopia: an economic evaluation

Abstract

Background Hepatitis B virus (HBV) infection is an important cause of morbidity and mortality with a very high burden in Africa. The risk of developing chronic infection is marked if the infection is acquired perinatally, which is largely preventable through a birth dose of HBV vaccine. We examined the cost-effectiveness of a birth dose of HBV vaccine in a medical setting in Ethiopia. Methods We constructed a decision analytic model with a Markov process to estimate the costs and effects of a birth dose of HBV vaccine (the intervention), compared with current practices in Ethiopia. Current practice is pentavalent vaccination (DPT-HiB-HepB) administered at 6, 10 and 14 weeks after birth. We used disability-adjusted life years (DALYs) averted to quantify the health benefits while the costs of the intervention were expressed in 2018 USD. Analyses were based on Ethiopian epidemiological, demographic and cost data when available; otherwise we used a thorough literature review, in particular for assigning transition probabilities. Results In Ethiopia, where the prevalence of HBV among pregnant women is 5%, adding a birth dose of HBV vaccine would present an incremental cost-effectiveness ratio (ICER) of USD 110 per DALY averted. The estimated ICER compares very favorably with a willingness-to-pay level of 0.31 times gross domestic product per capita (about USD 240 in 2018) in Ethiopia. Our ICER estimates were robust over a wide range of epidemiologic, vaccine effectiveness, vaccine coverage and cost parameter inputs. Conclusions Based on our cost-effectiveness findings, introducing a birth dose of HBV vaccine in Ethiopia would likely be highly cost-effective. Such evidence could help guide policymakers in considering including HBV vaccine into Ethiopia’s essential health services package.

Arresting vertical transmission of hepatitis B virus (AVERT-HBV) in pregnant women and their neonates in the Democratic Republic of the Congo: a feasibility study

“…Months since delivery should be prioritised as a prevention tool to reduce the risk of mother-to-child transmission. [22][23][24] Birth-dose vaccination was feasible in two high-volume maternity centres in urban Kinshasa, and was largely acceptable to mothers. Although we did not achieve vaccination within 24 h of birth for all infants, we showed that a high standard-of-care with adoption of a universal birth-dose vaccine is within reach in the Democratic Republic of the Congo.…”

Arresting Vertical Transmission of Hepatitis B Virus (AVERT-HBV) in the Democratic Republic of the Congo

“…Until such infrastructure is in place, HBV birth-dose should be prioritized as a prevention tool. [23][24][25] Birth-dose vaccination was feasible in two high-volume maternity centers in urban Kinshasa, DRC, and was largely acceptable to mothers. While we did not achieve vaccination within hours of birth for all infants, this feasibility study demonstrates that a higher standard-of-care is within reach in the DRC.…”

The costs of introducing a vaccine in sub-Saharan Africa: a systematic review of the literature

“…Some articles, focusing on vaccine supply chain per dose costs, report a range between US $0.43 and 1.21 (Mvundura et al, 2015). Others provide specific components estimations, such as cold chain (Constenla, 2015;Vaughan et al, 2020;Memirie et al, 2020), transportation (Cravioto et al, 2012), vehicles, gas price per liter and personnel costs (Vaughan et al, 2020;Portnoy et al, 2015). Some contributions interestingly distinguish between urban and rural facilities (Sch€ utte et al, 2015): delivery costs to rural centers, on average, are almost three times the costs of urban centers.…”

“…Sensitization and social mobilization are often estimated together and range from US $0.05 for a child fully immunized against cholera to US $0.069(Mogasale et al, 2016). Program preparation costs include training as well: sometimes the cost of training is computed as a separate element(Memirie et al, 2020), while in other papers it is computed with other components,Gosset et al (2021) estimate the cost of planning, budgeting, training, for the introduction of the Hepatitis B birth dose, in Senegal as equal to US $0.00535 Preparation costs are sometimes included in operating costs and considered as direct costs together with cold chain maintenance and vaccine administration costs(Carias et al, 2015) or they are not distinguished from service delivery and monitoring and surveillance costs(Colombini et al, 2015) Vaccine administration costs Nineteen studies out of those selected contain information on materials and supplies costs, either in percentage or in monetary terms. As reported in Table4, costs per dose of vaccine supplies range from US $0.06(Sch€ utte et al, 2015) to US $0.19(Antill on et al, 2017).…”