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Abstract Details
Assessing the cost-utility of preferentially administering Heplisav-B vaccine to certain populations
Vaccine. 2020 Nov 4;S0264-410X(20)31387-6. doi: 10.1016/j.vaccine.2020.10.067.Online ahead of print.
Elizabeth M Rosenthal1, Eric W Hall2, Eli S Rosenberg3, Aaron Harris4, Noele P Nelson4, Sarah Schillie4
Author information
1Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, NY, United States. Electronic address: emrosenthal@albany.edu.
2Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
3Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, NY, United States.
4Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States.
Abstract
Vaccination is the primary strategy to prevent hepatitis B virus (HBV) infection in the United States. Prior to 2017, most standard hepatitis B vaccine schedules required 3 doses over 6 months. Heplisav-B, approved in 2017, is administered in 2 doses over a 1 month time period but has a higher per-dose cost ($115.75 per dose compared to $57.25 per Engerix-B dose, costs as of June 1, 2019). We aimed to assess the cost-utility of providing the two-dose Heplisav-B vaccine compared to a three-dose Engerix-B vaccine among adult populations currently recommended for vaccination against hepatitis B. We used a decision-tree model with microsimulation and a Markov disease progression process to assess the cost-utility separately for the following populations: adults with diabetes, obesity, chronic kidney disease, HIV; non-responders to previous hepatitis B vaccination; older adults; and persons who inject drugs (PWID). We modeled epidemiologic outcomes (incident HBV infections, sequelae and related deaths), costs (2019 USD) and benefits (quality-adjusted life years, QALYs) and compared them across strategies. Sensitivity analyses assessed the cost-utility at varying estimates of Heplisav-B efficacy. In the base case scenario for each population, vaccination with Heplisav-B resulted in fewer HBV infections (37.5-59.8% averted), sequelae, and HBV-related deaths (36.3-71.4% averted). Heplisav-B resulted in decreased costs and increased benefits compared to Engerix-B for all populations except non-responders. Incremental costs from the baseline strategy ranged from $4746.78 saved (PWID) to $14.15 added cost (non-responders). Incremental benefits per person ranged from 0.00005 QALYs (older adults) to 0.7 QALYs (PWID). For persons with HIV and PWID, Heplisav-B resulted in lower costs and increased benefits in all scenarios in which Heplisav-B series efficacy was at least 80%. Vaccination using Heplisav-B is a cost-saving strategy compared to Engerix-B for adults with diabetes, chronic kidney disease, obesity, and HIV; older adults; and PWID.