Objective Through cost-benefit analysis (CBA),cost-effectiveness analysis (CEA) and quantitative optimization analysis to understand the economic benefit and outcomes of strategy regarding preventing mother-to-child transmission (PMTCT) on hepatitis B virus.Methods Based on the principle of Hepatitis B immunization decision analytic-Markov model,strategies on PMTCT and universal vaccination were compared.Related parameters of Shenzhen were introduced to the model,a birth cohort was set up as the study population in 2013.The net present value (NPV),benefit-cost ratio (BCR),incremental cost-effectiveness ratio (ICER) were calculated and the differences between CBA and CEA were compared.Results A decision tree was built as the decision analysis model for hepatitis B immunization.Three kinds of Markov models were used to simulate the outcomes after the implementation of vaccination program.The PMTCT strategy of Shenzhen showed a net-gain as 38 097.51 Yuan/per person in 2013,with BCR as 14.37.The universal vaccination strategy showed a net-gain as 37 083.03 Yuan/per person,with BCR as 12.07.Data showed that the PMTCT strategy was better than the universal vaccination one and would end with gaining more economic benefit.When comparing with the universal vaccination program,the PMTCT strategy would save 85 100.00 Yuan more on QALY gains for every person.The PMTCT strategy seemed more cost-effective compared with the one under universal vaccination program.In the CBA and CEA hepatitis B immunization programs,the immunization coverage rate and costs of hepatitis B related diseases were the most important influencing factors.Outcomes of joint-changes of all the parameters in CEA showed that PMTCT strategy was a more cost-effective.Conclusions The PMTCT strategy gained more economic benefit and effects on health.However,the cost of PMTCT strategy was more than the universal vaccination program,thus it is important to pay attention to the process of PMTCT strategy and the universal vaccination program.CBA seemed suitable for strategy optimization while CEA was better for strategy evaluation.Hopefully,programs as combination of the above said two methods would facilitate the process of economic evaluation.

Objective Since eliminating hepatitis B in China would need considerable public health resources,the economics problem of the strategy of community-based antiviral treatment for chronic hepatitis B (CHB) has become an important issue.The cost-effectiveness and affordability of the strategy were evaluated in this study.Methods According to the advocacy on eliminating hepatitis B by WHO and the comprehensive protocol of community based prevention of major infectious diseases and the guideline for CHB prevention and treatment in China,the decision analytic Markov model was constructed with the parameters from national surveys or Meta-analysis.A cohort population aged 20-59 years was used as study subjects.The strategy of CHB antiviral treatment was compared with the strategies of hepatitis B vaccination and non-intervention,respectively.The costs and disability-adjusted life years (QALYs) of the strategies were calculated from the societal and payer perspectives.The incremental cost-effectiveness ratio (ICER) and the cost-effectiveness ratio (CER)were calculated for the comparison of the strategies.One-way and probability sensitivity analysis were performed for uncertainty of the results.And the cost-effectiveness and affordability curves were introduced to estimate the budget impact on the strategies.Results In the Chinese aged 20-59 years,the ICER of CHB antiviral treatment was 37598.6 yuan (RMB) per QALYs and the ICERs were smaller in the low age groups,indicating that the antiviral treatment strategy is cost-effective and low age groups should be the priority population.The ICER of hepatitis B vaccination was-64 000.0 yuan (RMB) per QALYs,indicating that hepatitis B vaccination is cost saving.The CER of CHB antiviral treatment ranged from 731.8 to 1813.3 yuan (RMB) pcr QALYs compared with hepatitis B vaccination,and the CER of CHB antiviral treatment was higher than that of hepatitis B vaccination in all age groups,indicating that hepatitis B vaccination would be more cost-effective than CHB antiviral treatment.The price of antiviral drug,entercavir,can influence the cost effectiveness of CHB antiviral treatment.If the price of entercavir declined half,CHB antiviral treatment would be cost-saving.The probability sensitivity analysis showed that people's willing to pay for CHB antiviral treatment should not be ignored,although the results of economics evaluation of CHB antiviral treatment were reliable.The results of affordability analysis indicated that the antiviral treatment strategy could not be implemented with the budget lower than 30 million yuan (RMB),the probability of implementing the strategy was 42.6％ if the budget reaches 127 million yuan (RMB),and only when the budget reaches 269 million yuan (RMB),the goal of CHB antiviral treatment strategy can be fully realized.Conclusions Although the strategy of CHB antiviral treatment as prevention in Chinese aged 20-59 years is cost-effective,it is not an appropriate public health measure due to the high cost.The cost effectiveness would be higher by conducting hepatitis B vaccination and then antiviral treatment in susceptible population.

Objective To construct the Markov models to reflect the reality of prevention and treatment interventions against hepatitis B virus (HBV) infection,simulate the natural history of HBV infection in different age groups and provide evidence for the economics evaluations of hepatitis B vaccination and population-based antiviral treatment in China.Methods According to the theory and techniques of Markov chain,the Markov models of Chinese HBV epidemic were developed based on the national data and related literature both at home and abroad,including the settings of Markov model states,allowable transitions and initial and transition probabilities.The model construction,operation and verification were conducted by using software TreeAge Pro 2015.Results Several types of Markov models were constructed to describe the disease progression of HBV infection in neonatal period,perinatal period or adulthood,the progression of chronic hepatitis B after antiviral therapy,hepatitis B prevention and control in adults,chronic hepatitis B antiviral treatment and the natural progression of chronic hepatitis B in general population.The model for the newborn was fundamental which included ten states,i.e.susceptiblity to HBV,HBsAg clearance,immune tolerance,immune clearance,low replication,HBeAg negative CHB,compensated cirrhosis,decompensated cirrhosis,hepatocellular carcinoma (HCC) and death.The susceptible state to HBV was excluded in the perinatal period model,and the immune tolerance state was excluded in the adulthood model.The model for general population only included two states,survive and death.Among the 5 types of models,there were 9 initial states assigned with initial probabilities,and 27 states for transition probabilities.The results of model verifications showed that the probability curves were basically consistent with the situation of HBV epidemic in China.Conclusion The Markov models developed can be used in economics evaluation of hepatitis B vaccination and treatment for the elimination of HBV infection in China though the structures and parameters in the model have uncertainty with dynamic natures.

Objective To evaluate the cost effectiveness of nationwide prevention of mother to child transmission (PMTCT) strategy for hepatitis B,and estimate the willing to pay and budget impacts on the PMTCT.Methods The decision analytic Markov model for the PMTCT was constructed and a birth cohort of Chinese infants born in 2013 was used to calculate the cost-effectiveness of the PMTCT among them compared with those receiving no intervention.The parameters in the model were obtained from literatures of national surveys or Meta-analysis.The costs,cases of HBV-related diseases and quality-adjusted life-years (QALYs) were obtained from the societal and payer perspectives,respectively.The incremental cost-effectiveness ratio (ICER) was used as measures of strategy optimization.One-way and probability sensitivity analysis were performed to explore the uncertainty of the primary results.In addition,cost-effectiveness acceptability curve and cost-effectiveness affordability curves were drawn to illustrate the cost effectiveness threshold and financial budget of the PMTCT strategy.Results The lifetime cost for PMTCT strategy was 4 063.5 yuan (RMB) per carrier,which was 37 829.7 yuan (RMB) lower compared with those receiving no intervention.Due to the strategy,a total of 24.516 1 QALYs per person would be gained,which was higher than that in those receiving no intervention.From societal perspective,the ICER was-59 136.6yuan (RMB) per additional QALYs gained,indicating that the PMTCT is cost effective.The results were reliable indicated by one-way,multi-way and probability sensitivity analyses.By the CEAC,the willing to pay was much lower than the cost-effectiveness threshold.From the affordability curve of the PMTCT strategy,the annual budget ranged from 590.4 million yuan (RMB) to 688.8 million yuan (RMB),which was lower than the financial ability.Based on the results of cost-effectiveness affordability curves,the higher annual budget was determined,the higher probability of affordability for the PMTCT would be obtained under the same willing to pay state.Only when the annual budget reaches 688.8 million yuan (RMB),the goal of PMTCT would be fully realized.Conclusions The PMTCT strategy in China was cost effective,and the cost is not beyond the financial budget needed and the willing to pay.The strategy,which is consistent with the global hepatitis B elimination efforts,should be conducted widely in China.