Cost-effectiveness Analysis of Hepatitis E Screening and Vaccination: Targeting Vulnerable Populations in Outbreak and Sporadic Settings in China

This study evaluated the economic and health benefits of hepatitis E (HEV) screening and vaccination in both outbreak and sporadic settings in China. Decision-analytic Markov models were used to evaluate the population impact and cost-effectiveness of HEV screening and vaccination for people with chronic hepatitis B (CHB), older adults, pregnant women, and women of childbearing age. Simulations projected outcomes over six months for outbreak settings and lifetime horizons for sporadic settings. Incremental cost-effectiveness ratios (ICERs) were derived from a health system perspective with costs in 2023 US$. Robustness was examined through sensitivity analyses. Preventive universal screening combined with standard 3-dose HEV 239 vaccine was cost-effective only for people with CHB (Incremental cost-effectiveness ratio [ICER]: $25.38 thousand per Quality-Adjusted Life Year [QALY] gained), reducing symptomatic infections by 58.16% and HEV-related deaths by 57.51% in sporadic settings. This strategy may be economically viable for other vulnerable populations if the vaccine price is below $21 per dose. In outbreak settings, reactive universal screening combined with emergency 2-dose vaccination yielded cost-effective for older adults, pregnant women, and people with CHB (ICERs of $8.80, $26.26, and $31.81 thousand per QALY gained), reducing symptomatic infections and HEV-related deaths by over 70% within six months. In China, where sporadic settings are more common, preventive universal HEV screening combined with standard 3-dose vaccination is cost-effective only for people with CHB. High vaccine costs render this strategy economically unfeasible for older adults, pregnant women, and women of childbearing age.