Selective Hepatitis B Birth-Dose Vaccination in São Tomé and Príncipe: A Program Assessment and Cost-Effectiveness Study

Am J Trop Med Hyg. 2019 Oct;101(4):891-898. doi: 10.4269/ajtmh.18-0926.


São Tomé and Príncipe (STP) uses a selective hepatitis B birth-dose vaccination (HepB-BD) strategy targeting infants born to mothers who test positive for hepatitis B virus (HBV) surface antigen. We conducted a field assessment and economic analysis of the HepB-BD strategy to provide evidence to guide development of cost-effective policies to prevent perinatal HBV transmission in STP. We interviewed national stakeholders and key informants to understand policies, knowledge, and practices related to HepB-BD, vaccine management, and data recording/reporting. Cost-effectiveness of the existing strategy was compared with an alternate approach of universal HepB-BD to all newborns using a decision analytic model. Incremental cost-effectiveness ratios (ICERs) were calculated in 2015 USD per HBV-associated death and per chronic HBV case prevented, from the STP health-care system perspective. We found that STP lacked national or facility-specific written policies and procedures related to HepB-BD. Timely HepB-BD to eligible newborns was considered a high priority, although timeliness of HepB-BD was not monitored. Compared with the existing selective vaccination strategy, universal HepB-BD would result in a 19% decrease in chronic HBV infections per year at overall cost savings of approximately 44% (savings of USD 5,441 each year). We estimate an ICER of USD 5,012 saved per HBV-associated death averted. The existing selective HepB-BD strategy in STP could be improved through documentation of policies, procedures, and timeliness of HepB-BD. Expansion to universal newborn HepB-BD without maternal screening is feasible and could result in cost savings if actual implementation costs and effectiveness fall within the ranges modeled.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Cost-Benefit Analysis
  • Evidence-Based Medicine
  • Female
  • Hepatitis B / prevention & control*
  • Hepatitis B / virology
  • Hepatitis B Surface Antigens / immunology*
  • Hepatitis B Vaccines / administration & dosage*
  • Hepatitis B, Chronic / prevention & control*
  • Hepatitis B, Chronic / virology
  • Humans
  • Immunization Programs / economics*
  • Infant, Newborn
  • Infectious Disease Transmission, Vertical / prevention & control*
  • Parturition
  • Pregnancy
  • Program Evaluation
  • Sao Tome and Principe
  • Vaccination*
  • World Health Organization


  • Hepatitis B Surface Antigens
  • Hepatitis B Vaccines