OBJECTIVETo study the cost-effectiveness, benefit and utility of infant hepatitis B vaccination in Shanghai from 1992 to 2001.

METHODSTo calculate the cost of hepatitis B vaccination by cost analysis method. Both the numbers of persons with HBsAg positive and patient with hepatitis B, cirrhosis and liver cancer decreased as the index of direct effect. To study the sick-time and the cost of treating hepatitis B, cirrhosis and liver cancer patients, a face to face questionnaire was used and quasi method was adopted to understand the effect of cure and the course of hepatitis B. The cost benefit analysis method was also used to calculate the cost benefit of HBV vaccine. The disability adjusted life years (DALY) was regarded as an index of utility to measure the disease burden.

RESULTSInput of 501,129.49 Yuan might have the result of reducing one liver cancer patient, ten cirrhosis patients, one hundred chronic hepatitis B patients and one thousand HBsAg positive people. The cost of hepatitis B vaccination was 0.24 hundred million Yuan during the past ten years in Shanghai, which had obtained the total benefit value of 41.22 hundred million Yuan, with a cost benefit ratio of 1:172 Yuan. It was estimated that the total disease burden of hepatitis B, cirrhosis and liver cancer patients was 59,762.55 DALY in order to reduce one DALY loss cost of 402.50 Yuan.

CONCLUSIONHBV vaccine inoculation in infants seemed to be a low-cost input and high-effect output strategy.

Adult ; Cost-Benefit Analysis ; Female ; Hepatitis B ; complications ; economics ; prevention & control ; Hepatitis B Vaccines ; economics ; therapeutic use ; Humans ; Immunization Programs ; economics ; Infant, Newborn ; Liver Cirrhosis ; economics ; etiology ; Liver Neoplasms ; economics ; etiology ; Male ; Markov Chains ; National Health Programs ; Quality of Life ; Surveys and Questionnaires ; Vaccination

OBJECTIVETo evaluate long-term cost effectiveness of telbivudine and lamivudine for the treatment of CHB.

METHODSCost effectiveness was conducted from social health insurance perspective. A Markov model was established based on disease progression pattern and the data from the 2 years GLOBE clinical trial. The information of annual medical expenditure and quality-of-life assessment for different CHB-related diseases was obtained from literature. Incremental cost per life year or quality-adjusted life year gained was measured.

RESULTSCompared with lamivudine, the incremental cost for 1 additional QALY gained with telbivudine in treating HBeAg-positive and -negative CHB were 5403 yuan and 28239 yuan in Beijing, as well 4916 yuan and 29618 yuan in Guangzhou, respectively. According to national economic burden of CHB-related diseases, the ICER with telbivudine vs lamivudine were 1282 yuan and 31565 yuan for HBeAg-positive and -negative CHB.

CONCLUSIONAccording to WHO recommendation for ICER threshold, telbivudine is cost effective in treating HBeAg-positive and -negative CHB, as compared to lamivudine.

Adult ; Antifungal Agents ; economics ; therapeutic use ; China ; epidemiology ; Cost-Benefit Analysis ; DNA, Viral ; blood ; Drug Costs ; statistics & numerical data ; Economics, Pharmaceutical ; Female ; Hepatitis B e Antigens ; blood ; Hepatitis B, Chronic ; complications ; drug therapy ; economics ; epidemiology ; Humans ; Insurance, Long-Term Care ; Lamivudine ; economics ; therapeutic use ; Liver Cirrhosis ; etiology ; prevention & control ; Male ; Markov Chains ; Middle Aged ; Models, Economic ; Nucleosides ; economics ; therapeutic use ; Prescription Drugs ; economics ; Pyrimidinones ; economics ; therapeutic use ; Quality-Adjusted Life Years ; Thymidine ; analogs & derivatives

Hepatitis A can cause serious illness among adolescents and adults with low vaccination coverage. Even though hepatitis A vaccine is one of the strong candidates for Korean national immunization program, adolescents aged older than 12 yr would not benefit. Our purpose was to assess the willingness and analyze the correlates of Korean mothers for hepatitis A (HepA) vaccination to develop strategies for HepA vaccination. A national telephone survey on 800 mothers with children aged 7-18 yr was conducted with random-digit dialing method. Sixty-two percent and 92% of the mothers reported that they were willing to HepA vaccination at current cost and at half of the current cost, respectively. However, at current cost, only 79% wished to vaccinate their child in an epidemic and 32% wished to vaccinate promptly. Having two or more children, not having future plans to send the child overseas, and low family income were significantly associated with not willing to HepA vaccination. Low perception of the susceptibility for hepatitis A and perception of the current cost as barrier increased the odds of unwillingness to vaccination at current cost and to prompt vaccination. The mothers' willingness to HepA vaccination for the children aged 7-18 yr in Korea was not very high at current cost and associated socioeconomic status and health-belief. Targeted intervention or strategies are needed to increase the HepA vaccination rate among children in Korea.
Adolescent ; Adult ; Child ; Demography ; Female ; Health Status ; Health Surveys ; Hepatitis A/economics/*prevention & control ; Hepatitis A Vaccines/economics/*immunology ; Humans ; Interviews as Topic ; Male ; Middle Aged ; Mothers/psychology ; Republic of Korea ; Social Class ; *Vaccination

OBJECTIVETo explore the feasibility of replacement of ordinary syringes by auto-disposal syringes (AD) in China.

METHODSSampling survey was conducted in Hebei province to collect data on the direct medical spending of hepatitis B and their Disability Adjusted Life Year (DALY) losses. The financial burden on hepatitis B was calculated based on the result of field survey as well as through data-base of the Second National Health Services Survey of MOH in 1998. The cost-benefit analysis was employed, in which the saving of the financial burden on hepatitis B patients attributing to unsafe injections was taken as the benefit of intervention and the increased expenditures of AD syringes as the costs.

RESULTSThe total financial disease burden of Hepatitis B in China in 2001 was between RMB 16.19 and 20.17 billion Yuan and the financial disease burden per patient was between RMB 1755.38 and 1409.64 Yuan. Study on the cost-benefit analysis in the replacement intervention program showed high financial feasibility. The Benefit-Cost Ratio (BCR) of the measure was between 32.46 and 97.39, which was bigger in rural areas than that in cities. The direct BCR was less than one when the price gap between ordinary syringe and AD exceeded RMB 0.24 Yuan.

CONCLUSIONThe intervention of safe injection practice through universal usage of AD to replace ordinary syringe seemed to be applicable due to its high potential economic benefits.

China ; epidemiology ; Cost-Benefit Analysis ; Cross Infection ; economics ; etiology ; prevention & control ; Cross-Sectional Studies ; Disposable Equipment ; economics ; statistics & numerical data ; Equipment Reuse ; statistics & numerical data ; Female ; Hepatitis B ; economics ; transmission ; Humans ; Injections ; adverse effects ; economics ; instrumentation ; Male ; Risk Factors ; Sampling Studies ; Surveys and Questionnaires ; Syringes ; economics