ScienceDirect | 10/05/2020
Vaccination is the primary strategy to prevent hepatitis B virus (HBV)
infection in the United States. Prior to 2017, most standard hepatitis B
vaccine schedules required 3 doses over 6 months. Heplisav-B, approved
in 2017, is administered in 2 doses over a 1 month time period but has a
higher per-dose cost ($115.75 per dose compared to $57.25 per Engerix-B
dose, costs as of June 1, 2019). We aimed to assess the cost-utility of
providing the two-dose Heplisav-B vaccine compared to a three-dose
Engerix-B vaccine among adult populations currently recommended for
vaccination against hepatitis B. We used a decision-tree model with
microsimulation and a Markov disease progression process to assess the
cost-utility separately for the following populations: adults with
diabetes, obesity, chronic kidney disease, HIV; non-responders to
previous hepatitis B vaccination; older adults; and persons who inject
drugs (PWID). We modeled epidemiologic outcomes (incident HBV
infections, sequelae and related deaths), costs (2019 USD) and benefits
(quality-adjusted life years, QALYs) and compared them across
strategies. Sensitivity analyses assessed the cost-utility at varying
estimates of Heplisav-B efficacy. In the base case scenario for each
population, vaccination with Heplisav-B resulted in fewer HBV infections
(37.5–59.8% averted), sequelae, and HBV-related deaths (36.3–71.4%
averted). Heplisav-B resulted in decreased costs and increased benefits
compared to Engerix-B for all populations except non-responders.
Incremental costs from the baseline strategy ranged from $4746.78 saved
(PWID) to $14.15 added cost (non-responders). Incremental benefits per
person ranged from 0.00005 QALYs (older adults) to 0.7 QALYs (PWID). For
persons with HIV and PWID, Heplisav-B resulted in lower costs and
increased benefits in all scenarios in which Heplisav-B series efficacy
was at least 80%. Vaccination using Heplisav-B is a cost-saving strategy
compared to Engerix-B for adults with diabetes, chronic kidney disease,
obesity, and HIV; older adults; and PWID.
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