Assessing the Cost-Utility of Universal Hepatitis B Vaccination Among Adults

J Infect Dis. 2022 Sep 21;226(6):1041-1051. doi: 10.1093/infdis/jiac088.


Background: Although effective against hepatitis B virus (HBV) infection, hepatitis B (HepB) vaccination is only recommended for infants, children, and adults at higher risk. We conducted an economic evaluation of universal HepB vaccination among US adults.

Methods: Using a decision analytic model with Markov disease progression, we compared current vaccination recommendations (baseline) with either 3-dose or 2-dose universal HepB vaccination (intervention strategies). In simulated modeling of 1 million adults distributed by age and risk groups, we quantified health benefits (quality-adjusted life years, QALYs) and costs for each strategy. Multivariable probabilistic sensitivity analyses identified key inputs. All costs reported in 2019 US dollars.

Results: With incremental base-case vaccination coverage up to 50% among persons at lower risk and 0% increment among persons at higher risk, each of 2 intervention strategies averted nearly one-quarter of acute HBV infections (3-dose strategy, 24.8%; 2-dose strategy, 24.6%). Societal incremental cost per QALY gained of $152 722 (interquartile range, $119 113-$235 086) and $155 429 (interquartile range, $120 302-$242 226) were estimated for 3-dose and 2-dose strategies, respectively. Risk of acute HBV infection showed the strongest influence.

Conclusions: Universal adult vaccination against HBV may be an appropriate strategy for reducing HBV incidence and improving resulting health outcomes.

Keywords: United States; economic evaluation; hepatitis B; vaccination.

Publication types

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

MeSH terms

  • Adult
  • Child
  • Cost-Benefit Analysis
  • Hepatitis B Vaccines
  • Hepatitis B virus
  • Hepatitis B* / epidemiology
  • Hepatitis B* / prevention & control
  • Humans
  • Infant
  • Phenylbutyrates
  • Quality-Adjusted Life Years
  • Vaccination


  • Hepatitis B Vaccines
  • Phenylbutyrates
  • gamma-hydroxy-gamma-ethyl-gamma-phenylbutyramide