Methods
We developed an enlarged Susceptible-Exposed-Infectious-Recovered (SEIR) model as well as a decision tree-Markov model to estimate the HBV epidemic in China, analyze the feasibility of 2030 Elimination Goals through forecasts, and undertake economic analysis. The enlarged SEIR model was calibrated using yearly data from laboratory-confirmed HBV cases from 1990 to 2018. Two models were utilized separately to compare the prevalence of chronic HBV infections, quality-adjusted life-years (QALYs), incremental cost effectiveness ratio, and benefit-cost ratio (BCR) under various intervention choices, providing a foundation for exploring new containment techniques.
Results
The number of chronic HBV infections fell by 33.9% between 1990 and 2020. In 2030, the current status quo will result in 55.73 million infections (3.95% prevalence), compared to 90.63 million (6.42% prevalence) in the "Without the NIP" scenario (NIP: National Immunization Program), and 114.78 million (8.13% prevalence) in the absence of any interventions. The prevention of mother-to-child transmission (PMTCT) method resulted in a net benefit of $12,283.50 per person, with a BCR of 12.66, which is greater than the 9.49 for universal immunization. The PMTCT method might save 7726.03 dollars per QALY increase as compared to no screening and no vaccination.
Conclusions
After approximately 30 years of implementation of the national hepatitis B immunization program, which also provided containment experience for high or medium burden countries, our findings demonstrated that HBV vaccination has demonstrated a significant positive impact on controlling the HBV epidemic in terms of effectiveness and economy. In China, the next step should be to investigate techniques to increase diagnostic and treatment coverage in order to reduce the burden of HBV-related fatalities and, eventually, eliminate HBV.