ABSTRACT
Background: Globally, Haemophilus influenzae type b (Hib) vaccine has substantially reduced the burden of Hib invasive disease, However, China remains the only World Health Organization (WHO) member country not to include Hib vaccine into its national immunization program (NIP), although it accounts for 11% of global Hib deaths. Hib vaccines are paid by individuals 100% out of pocket in the private market so the coverage rates in China are relatively low and very diversified by regions and income levels.Meanwhile, provincial level estimates are particularly needed, as provinces in China can make their own policies of adding new vaccines according to the Vaccine Management Law newly released in 2019. We aimed to assess the cost-effectiveness of including Hib vaccine in China’s NIP at the national and provincial levels.
Methods: Using a decision-tree Markov state transition model, we estimated the cost-effectiveness of Hib vaccine in the NIP compared to the status quo for the 2017 birth cohort. Data on treatment costs and vaccine program costs were derived and calculated from China Center for Disease Control and Prevention (CDC) and national health insurance databases from China Healthcare Insurance Research Association (CHIRA). Hib disease burden data and other model parameters were obtained from international published data. Hib cases and deaths averted, quality-adjusted life years (QALYs) gained, and incremental cost-effectiveness ratios (ICER) were predicted by province and nationally. One-way, scenario and probabilistic sensitivity analyses were done to explore model uncertainties.
Findings: Including Hib vaccine in the NIP was projected to prevent 2,977 deaths (93% reduction) and 252,171 cases of Hib disease (92% reduction) for the birth cohort at the national level. The inclusion of the Hib vaccine in the NIP was cost-effective in 28 of 31 provinces, including cost-saving in Tibet, Xinjiang and Qinghai, and highly cost-effective nationally with an ICER of US$ 7872 per QALY gained. One-way and scenario sensitivity analyses indicated results were robust when varying model parameters. In probabilistic sensitivity analysis, Hib vaccine had a 70% probability of being highly cost-effective. When accounting for herd immunity, Hib vaccine in the NIP remained cost-effective nationally and in 13 provinces.
Interpretation: The introduction of Hib vaccine in China’s NIP is highly cost-effective nationally and provincially in most provinces. Provinces with lower socioeconomic status, higher disease burden and limited access to Hib vaccine in the current private market, such as those in the west region, would benefit the most from adding Hib vaccine to the NIP. In the absence of a national policy decision on Hib vaccine, this analysis provides evidence for provincial governments to include Hib vaccine into local immunization programs to substantially reduce disease burden and treatment costs