Assessment of cost-effectiveness of universal hepatitis B immunization in a low-income country with intermediate endemicity using a Markov model

J Hepatol. 2003 Feb;38(2):215-22. doi: 10.1016/s0168-8278(02)00382-3.


Background/aims: Most countries with high hepatitis B (HB) virus endemicity and most high-income countries have introduced immunization programmes against this infection. However, several low-income countries with intermediate HB endemicity have not done so. We performed a cost-effectiveness analysis of universal childhood HB immunization in such countries using India as an example, since available data on this aspect are limited.

Methods: Marginal cost of every life-year and quality-adjusted life-year (QALY) gained with universal HB vaccination was calculated using a Markov model. Two types of analyses (including and excluding expenditure on treatment of long-term complications of HB infection) were done. Several sensitivity analyses and Monte-Carlo simulation were performed.

Results: Universal immunization reduced the HB carrier rate by 71%, and increased the number of years and QALY lived by a birth-cohort by 0.173 years (61.072 vs. 60.899 years) and 0.213 years (61.056 vs. 60.843 years), respectively. Marginal costs were US$16.27 per life-year gained and US$13.22 per QALY gained, much lower than annual per capita income. One-way sensitivity analysis and Monte-Carlo simulation confirmed the robustness of the conclusions.

Conclusions: Universal HB immunization is highly cost-effective in low-income countries with intermediate endemicity rates.

Publication types

  • Evaluation Study

MeSH terms

  • Cost-Benefit Analysis
  • Developing Countries / economics
  • Disease Progression
  • Endemic Diseases / economics
  • Endemic Diseases / prevention & control*
  • Health Care Costs / statistics & numerical data*
  • Hepatitis B / economics
  • Hepatitis B / epidemiology
  • Hepatitis B / prevention & control*
  • Hepatitis B Vaccines / economics*
  • Humans
  • Immunization Programs / economics*
  • India / epidemiology
  • Markov Chains
  • Models, Econometric
  • Monte Carlo Method
  • Poverty
  • Program Evaluation
  • Quality-Adjusted Life Years
  • Value of Life / economics


  • Hepatitis B Vaccines