Cost-effectiveness of birth-dose hepatitis B vaccination among refugee populations in the African region: a series of case studies
Abstract Background Hepatitis B affects 257 million people worldwide. Mother-to-child hepatitis B virus (HBV) transmission is a preventable cause of substantial morbidity and mortality and poses greatest risk for developing chronic HBV infection. The World Health Organization recommends that all cou...
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| Format: | Article |
| Language: | English |
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BMC
2019-02-01
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| Series: | Conflict and Health |
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| Online Access: | http://link.springer.com/article/10.1186/s13031-019-0188-y |
| _version_ | 1818030282180132864 |
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| author | Joseph Michael Reardon Siobhán M. O’Connor Joseph D. Njau Eugene K. Lam Catherine A. Staton Susan T. Cookson |
| author_facet | Joseph Michael Reardon Siobhán M. O’Connor Joseph D. Njau Eugene K. Lam Catherine A. Staton Susan T. Cookson |
| author_sort | Joseph Michael Reardon |
| collection | DOAJ |
| description | Abstract Background Hepatitis B affects 257 million people worldwide. Mother-to-child hepatitis B virus (HBV) transmission is a preventable cause of substantial morbidity and mortality and poses greatest risk for developing chronic HBV infection. The World Health Organization recommends that all countries institute universal hepatitis B birth dose (HepB BD) vaccination during the first 24 h of life, followed by timely completion of routine immunization. The objective of this analysis was to assess the cost-effectiveness of adding HepB BD vaccination among sub-Saharan African refugee populations where the host country’s national immunization policy includes HepB BD. Methods We performed a cost-effectiveness analysis of three hepatitis B vaccination strategy scenarios for camp-based refugee populations in the African Region (AFR): routine immunization (RI), RI plus universal HepB BD, and RI plus HepB BD only for newborns of hepatitis B surface antigen-positive mothers identified through rapid diagnostic testing (RDT). We focused analyses on refugee populations living in countries that include HepB BD in national immunization schedules: Djibouti, Algeria and Mauritania. We used a decision tree model to estimate costs of vaccination and testing, and costs of life-years lost due to complications of chronic hepatitis B. Results Compared with RI alone, addition of HepB BD among displaced Somali refugees in Djibouti camps would save 9807 life-years/year, with an incremental cost-effectiveness ratio (ICER) of 0.15 USD (US dollars) per life-year saved. The RI plus HepB BD strategy among Western Saharan refugees in Algerian camps and Malian refugees in Mauritania camps would save 27,108 life-years/year with an ICER of 0.11 USD and 18,417 life-years/year with an ICER of 0.16 USD, respectively. The RI plus RDT-directed HepB BD was less cost-effective than RI plus delivery of universal HepB BD vaccination or RI alone. Conclusions Based on our model, addition of HepB BD vaccination is very cost-effective among three sub-Saharan refugee populations, using relative life-years saved. This analysis shows the potential benefit of implementing HepB BD vaccination among other camp-based refugee populations as more AFR countries introduce national HepB BD policies. |
| first_indexed | 2024-12-10T05:33:06Z |
| format | Article |
| id | doaj.art-b5d732b8f4ad4975b5be6f08e58f707d |
| institution | Directory Open Access Journal |
| issn | 1752-1505 |
| language | English |
| last_indexed | 2024-12-10T05:33:06Z |
| publishDate | 2019-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Conflict and Health |
| spelling | doaj.art-b5d732b8f4ad4975b5be6f08e58f707d2022-12-22T02:00:29ZengBMCConflict and Health1752-15052019-02-0113111010.1186/s13031-019-0188-yCost-effectiveness of birth-dose hepatitis B vaccination among refugee populations in the African region: a series of case studiesJoseph Michael Reardon0Siobhán M. O’Connor1Joseph D. Njau2Eugene K. Lam3Catherine A. Staton4Susan T. Cookson5Department of Emergency Medicine, Greenville Health SystemDivision of Viral Hepatitis, United States Centers for Disease Control and PreventionDivision of Global Migration and Quarantine, United States Centers for Disease Control and PreventionDivision of Global Health Protection, United States Centers for Disease Control and PreventionDivision of Emergency Medicine, Duke University Medical CenterEmergency Response and Recovery Branch, Division of Global Health Protection, United States Centers for Disease Control and PreventionAbstract Background Hepatitis B affects 257 million people worldwide. Mother-to-child hepatitis B virus (HBV) transmission is a preventable cause of substantial morbidity and mortality and poses greatest risk for developing chronic HBV infection. The World Health Organization recommends that all countries institute universal hepatitis B birth dose (HepB BD) vaccination during the first 24 h of life, followed by timely completion of routine immunization. The objective of this analysis was to assess the cost-effectiveness of adding HepB BD vaccination among sub-Saharan African refugee populations where the host country’s national immunization policy includes HepB BD. Methods We performed a cost-effectiveness analysis of three hepatitis B vaccination strategy scenarios for camp-based refugee populations in the African Region (AFR): routine immunization (RI), RI plus universal HepB BD, and RI plus HepB BD only for newborns of hepatitis B surface antigen-positive mothers identified through rapid diagnostic testing (RDT). We focused analyses on refugee populations living in countries that include HepB BD in national immunization schedules: Djibouti, Algeria and Mauritania. We used a decision tree model to estimate costs of vaccination and testing, and costs of life-years lost due to complications of chronic hepatitis B. Results Compared with RI alone, addition of HepB BD among displaced Somali refugees in Djibouti camps would save 9807 life-years/year, with an incremental cost-effectiveness ratio (ICER) of 0.15 USD (US dollars) per life-year saved. The RI plus HepB BD strategy among Western Saharan refugees in Algerian camps and Malian refugees in Mauritania camps would save 27,108 life-years/year with an ICER of 0.11 USD and 18,417 life-years/year with an ICER of 0.16 USD, respectively. The RI plus RDT-directed HepB BD was less cost-effective than RI plus delivery of universal HepB BD vaccination or RI alone. Conclusions Based on our model, addition of HepB BD vaccination is very cost-effective among three sub-Saharan refugee populations, using relative life-years saved. This analysis shows the potential benefit of implementing HepB BD vaccination among other camp-based refugee populations as more AFR countries introduce national HepB BD policies.http://link.springer.com/article/10.1186/s13031-019-0188-yHepatitis BrefugeeAfricacost-effectivenessDjiboutiAlgeria |
| spellingShingle | Joseph Michael Reardon Siobhán M. O’Connor Joseph D. Njau Eugene K. Lam Catherine A. Staton Susan T. Cookson Cost-effectiveness of birth-dose hepatitis B vaccination among refugee populations in the African region: a series of case studies Conflict and Health Hepatitis B refugee Africa cost-effectiveness Djibouti Algeria |
| title | Cost-effectiveness of birth-dose hepatitis B vaccination among refugee populations in the African region: a series of case studies |
| title_full | Cost-effectiveness of birth-dose hepatitis B vaccination among refugee populations in the African region: a series of case studies |
| title_fullStr | Cost-effectiveness of birth-dose hepatitis B vaccination among refugee populations in the African region: a series of case studies |
| title_full_unstemmed | Cost-effectiveness of birth-dose hepatitis B vaccination among refugee populations in the African region: a series of case studies |
| title_short | Cost-effectiveness of birth-dose hepatitis B vaccination among refugee populations in the African region: a series of case studies |
| title_sort | cost effectiveness of birth dose hepatitis b vaccination among refugee populations in the african region a series of case studies |
| topic | Hepatitis B refugee Africa cost-effectiveness Djibouti Algeria |
| url | http://link.springer.com/article/10.1186/s13031-019-0188-y |
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