Cost-effectiveness of universal infant hepatitis B vaccination programme in Finland

OBJECTIVES: To evaluate the cost-effectiveness of a universal infant hepatitis B vaccination programme in Finland. METHODS: A static cohort model was employed to compare the health care costs and health effects of a universal infant hepatitis B vaccination programme with the present targeted vaccination programme. Estimates of hepatitis B incidence and hepatitis B-related costs were derived from national register data. The estimated hepatitis B incidence took into account acute asymptomatic infections. An annual discount rate of 3% was applied to costs and health effects and the main outcome measure was cost per quality adjusted life year (QALY) gained. We present the results with different price differences per dose of hexavalent and pentavalent vaccines. Sensitivity analyses identified influential inputs in the cost-effectiveness analysis. RESULTS: We estimated 41 acute cases with every fifth being symptomatic, three chronic hepatitis B cases, and three hepatitis B-related deaths in a birth cohort of 58,000 children. The corresponding health care costs were ϵ46,400 and QALYs lost 14.4. The incremental cost-effectiveness ratios (ICER) were between ϵ24,500 and ϵ162,900 when the price difference per dose of pentavalent versus hexavalent vaccine was between two and 12 euros. The results were sensitive to hepatitis B incidence, vaccine cost, and discount rate. CONCLUSIONS: In a very low hepatitis B prevalence country such as Finland, a universal infant hepatitis B vaccination programme appears justifiable use of public health care resources only with a very small price difference between pentavalent and hexavalent vaccines.