Cost-effectiveness of hepatitis B vaccination using HEPLISAV™ in selected adult populations compared to Engerix-B® vaccine.

Abstract

OBJECTIVE:

HEPLISAV™ is an adult hepatitis B vaccine that requires fewer doses over a shorter period of time and elicits higher and earlier seroprotection compared to Engerix-B to reduce the risk of hepatitis B infection. The objective of this analysis was to evaluate the cost-effectiveness of vaccination with HEPLISAV vs. Engerix-B(®) to prevent hepatitis B infection in select populations.

METHODS:

Markov models were developed for the following populations: diabetics, patients with chronic or end stage kidney disease, healthcare workers and international travelers to countries with high HBV infection prevalence. Hepatitis B disease progression was modeled using 11 health states: seroprotected, susceptible, acute infection, chronic infection, fulminant hepatic failure, compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, liver transplant, post-transplant care, and death. Seroprotection rates were obtained from two phase 3 clinical trials comparing HEPLISAV with Engerix-B and ranged across various populations from 89-96% for HEPLISAV and 62-81% for Engerix-B. Higher vaccination completion rates were assumed for HEPLISAV compared with Engerix-B given that fewer doses of HEPLISAV are required in a shorter period of time to achieve seroprotection for the evaluated populations. Each cycle length after the first year in the model was 1-year. All future costs and benefits were discounted at 3%. A lifetime analysis and a U.S. payer perspective were used.

RESULTS:

HEPLISAV has a favorable cost-effectiveness profile with incremental cost effectiveness ratios <$25,000 across all populations studied. In the patients with chronic or end stage kidney disease, HEPLISAV was the dominant option and was cost-saving compared with Engerix-B. The cost of vaccine, regimen completion rates, and seroprotection rates were the sensitive variables in the models.

CONCLUSIONS:

HEPLISAV is a cost-effective option to provide high rates of seroprotection and early seroprotection across a range of populations from health care workers to patients with chronic or end stage kidney disease.

• Authors: Renee Kim Kuan, Robert Janssen, William Heyward, Sean Bennett, Robert Nordyke
• Journal: Vaccine (Vaccine) Vol. 31 Issue 37 Pg. 4024-32 (Aug 20 2013) ISSN: 1873-2518 [Electronic] Netherlands
• PMID: 23707166 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2013 Elsevier Ltd. All rights reserved.

Chemical References

• Engerix-B
• Hepatitis B Vaccines

Topics

• Adolescent
• Adult
• Aged
• Cost-Benefit Analysis
• Diabetes Mellitus (economics, virology)
• Health Personnel
• Hepatitis B (prevention & control)
• Hepatitis B Vaccines (administration & dosage, economics, therapeutic use)
• Humans
• Kidney Failure, Chronic (economics, virology)
• Markov Chains
• Middle Aged
• Models, Economic
• Models, Theoretical
• Probability
• Renal Insufficiency, Chronic (economics, virology)
• Young Adult