Cost-effectiveness analysis of hepatitis E screening and vaccination: targeting vulnerable populations in outbreak and sporadic settings in China

This peer-reviewed article evaluates the cost-effectiveness of hepatitis E virus (HEV) screening and vaccination strategies targeting vulnerable populations in China across both sporadic and outbreak settings. Using decision-analytic Markov models, researchers assessed the health and economic impact of HEV screening combined with vaccination among people with chronic hepatitis B (CHB), older adults, pregnant women, and women of childbearing age. The analysis modelled lifetime outcomes for sporadic transmission settings and six-month outcomes for outbreak settings from a health system perspective.

Key findings

• In sporadic settings, preventive HEV screening combined with a standard 3-dose vaccination strategy was cost-effective only for people with CHB, reducing symptomatic infections by 58% and HEV-related deaths by 58%.
• For older adults, pregnant women, and women of childbearing age, vaccination in sporadic settings was not cost-effective at current vaccine prices.
• In outbreak settings, reactive screening combined with emergency 2-dose vaccination was cost-effective for people with CHB, older adults, and pregnant women, reducing symptomatic infections and HEV-related deaths by more than 70% within six months.
• Vaccine price strongly influenced cost-effectiveness outcomes: for several target groups, vaccination became economically viable only if the vaccine price dropped below approximately US$21 per dose.
• The study highlights that delayed outbreak response reduces the cost-effectiveness of vaccination strategies, underlining the importance of rapid detection and intervention.

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