Cost‐Effectiveness Analysis of Hepatitis E Vaccination Strategies for Swine Workers

Hepatitis E virus (HEV) is endemic in China, with swine as the most common reservoir. It poses a zoonotic public health risk to swine workers. This study evaluated the cost‐effectiveness of hepatitis E vaccination for this high‐risk group in China. A decision tree‐Markov model was utilized to evaluate the cost‐effectiveness of two hepatitis E vaccination strategies, without or following screening, for swine workers aged 16–60 in China from societal perspectives, compared to no vaccination. We calculated HEV‐related cases and deaths averted, quality‐adjusted life years (QALYs) gained, and incremental cost‐effectiveness ratios (ICERs) with a willingness‐to‐pay (WTP) threshold of GDP per capita. A sensitivity analysis was conducted. Additionally, we stimulated the scenarios of fully receiving 3‐dose schedule, partially receiving 3‐dose schedule, and fully receiving 2‐dose schedule. Both hepatitis E vaccination strategies significantly reduced HEV‐related cases and deaths compared to no vaccination. ICERs were estimated to be USD 11,428.16 and 9830.71/QALY averted for vaccination without and following screening, respectively, both lower than GDP per capita (USD 12,325.24, 2023). Furthermore, one‐way sensitivity analysis identified the discount rate, utility in asymptomatic cases, and probability of symptomatic infection as crucial factors affecting ICER. Probabilistic sensitivity analysis (PSA) showed a 47.5% cost‐effectiveness probability for hepatitis E vaccination following screening, compared to 52.5% for no vaccination. Notably, vaccination following screening was cost‐ineffective after age 40 and at a price of USD 138.0/dose. Additionally, fully receiving 2‐dose and partially 3‐dose schedules were cost‐effective, regardless of hepatitis E vaccination without or following screening strategies, while fully receiving 3‐dose schedule was cost‐ineffective with the vaccination without screening strategy. Hepatitis E vaccination following screening would be optimal for swine workers in China. Vaccination starting at an earlier age and lower vaccine prices can improve the cost‐effectiveness. Additionally, 2‐dose schedule may be recommended during a hepatitis E outbreak to achieve cost‐effectiveness.