Cost-utility analysis of adding a fourth dose at birth to the hepatitis B vaccination schedule in Côte d’Ivoire

Abstract

Background. Côte d’Ivoire is considering adding a birth dose of the Hepatitis B vaccine to the current vaccination schedule (at 6, 10, and 14 weeks) in order to decrease vertical transmissions. The study aims to perform a cost-utility analysis of adding the extra Hepatitis B dose at birth.

Methods: Using a Markov model which included economic and epidemiological data, the incremental cost-effectiveness ratio (ICER) per averted disability-adjusted life years (DALYs) of adding a birth dose was calculated using a 3% discount rate. Parameter values in the model were obtained from experts’ interviews in Cote d’Ivoire, WHO Global Health Observatory data, international publications and hospital reports. Univariate sensitivity analyses were performed to account for uncertainty.

Results: In 2018, under the base case (no-vaccination) scenario, 3,940 out of the newborn cohort of 947,687 would become HBV carriers. Under the current three-dose vaccination regimen, only 947 are at risk. Adding a birth dose will reduce this by a further 104 transmissions to 843 cases. The birth dose costs $1.02 per fully immunized child, totaling $899,000 per annual birth cohort, these are exceeded by $1,627,000 savings in lifetime treatment costs. An estimated 823 DALYs will be averted due to decreased morbidity and mortality. Adopting a four-dose immunization schedule is cost-saving, cost-effective and very cost-effective when vaccine efficacy gains (relative to the current three dose-schedule) are above 1.56%, 0.35% and 0.72% respectively.

Conclusion: Since our model shows it is likely to be a cost-saving strategy, we recommend introducing the fourth dose of HBV immunization at birth in Cote d’Ivoire.