Cost-Effectiveness Analysis of Hepatitis B Immunization in Vietnam: Application of Cost-Effectiveness Affordability Curves in Health Care Decision Making

Hong Anh T. Tu*, Robin de Vries, Herman J. Woerdenbag, Shu Chuen Li, Hoa H. Le, Marinus van Hulst, Maarten J. Postma

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

14 Citations (Scopus)
26 Downloads (Pure)


Objectives: To perform acost-effectiveness analysis and to identify the coseffectiveness affordability levels for a newborn universal vaccination program against hepatitis B virus (HBV) in Vietnam. Methods: By using a Markov model, we simulated a Vietnamese birth cohort using 1,639,000 newborns in 2002 and estimated the incremental cost-effectiveness ratios for quality-adjusted life-year gained following universal newborn HBV vaccination. Two types of analyses were performed, including and excluding expenditures on the treatment of chronic hepatitis B and its complications. We used Monte Carlo simulations to examine cost-effectiveness acceptability and affordability from the payer's perspective and constructed a cost-effectiveness affordability curve to assess the costs and health effects of the program. Results: In the base-case analysis, newborn universal HBV vaccination reduced the carrier rate by 58% at a cost of US $42 per carrier averted. From the payer's perspective, incremental cost-effectiveness ratio per quality-adjusted life-year gained was US $3.77, much lower than the 2002 per-capita gross domestic product of US $440. Vaccination could potentially be affordable starting at a US $2.1 million budget. At the cost-effectiveness threshold of US $3.77 per quality-adjusted life-year and an annual budget of US $5.9 million, the probability that vaccination will be both cost-effective and affordable was 21%. Conclusions: Universal newborn HBV vaccination is highly cost-effective in Vietnam. In low-income, high-endemic countries, where funds are limited and the economic results are uncertain, our findings on the cost-effectiveness affordability options may assist decision makers in proper health investments. © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR).
Original languageEnglish
Pages (from-to)7-14
Number of pages8
JournalValue in Health Regional Issues
Issue number1
Publication statusPublished - 1-May-2012


  • Acceptability
  • Affordability
  • Cost-effectiveness
  • Incremental cost-effectiveness ratio
  • Quality-adjusted life-year
  • hepatitis B vaccine
  • article
  • budget
  • chronic hepatitis
  • controlled study
  • cost benefit analysis
  • cost effectiveness analysis
  • drug cost
  • gross national product
  • hepatitis B
  • Hepatitis B virus
  • human
  • infection control
  • infection prevention
  • infection rate
  • mass immunization
  • medical decision making
  • newborn
  • outcome assessment
  • priority journal
  • quality adjusted life year
  • sensitivity analysis
  • Viet Nam

Cite this