Cost-Utility Analysis of Expanding Hepatitis B Vaccination Among Healthcare Workforce in Ethiopia

Objective Ethiopia is one of the countries with high endemicity of hepatitis B infection. In Ethiopia, the current vaccine coverage among health care workers accounts for around 14%. Most health workforce (241,250) of Ethiopia was first considered as susceptible with a probability of getting Hepatitis B Virus acutely and 5–10% chance of progressing to chronic Hepatitis B. Hence, examining cost-utility analysis of hepatitis B vaccination coverage among healthcare workers in Ethiopia was found the most essential work.Method Markov model for expanding vaccination coverage (3 doses of hepatitis B vaccine) was simulated based on the data obtained both primary and secondary data. A secondary data particularly cost and effectiveness data were obtained from published articles, World Health Organization (WHO) guidelines and Ethiopian Federal Ministry of Health (FMOH) documents. Moreover, cost related data for vaccination and chronic hepatitis B treatment were also gathered by interviewing expertise from Tikur Anbesa Specialized Hospital (TASH). This study was conducted from a healthcare payer perspective, with 3% discount rate of cost and health outcome as WHO recommendation. Primarily health outcome was measured by Quality Adjusted Life Year (QALY) gain and Incremental Cost-Effectiveness Ratio (ICER). Deterministic analysis and tornado diagrams were employed to manage parameter uncertainty and show a plausible range of cost and effectiveness of variables.Result Current vaccination program is more expensive (USD 29.99) with a positive incremental cost of USD 1.32 and less effective that have negative incremental effectiveness of -0.08 and total life year gains of 28.54 than Expanded Hepatitis B vaccination strategy which costs USD 28.67 and gives relatively high total life-year gain of 28.62. The resulting ICER was USD 16.23 per QALY gained. However, the ICER was a negative for the current vaccination strategy that could show, it was dominated by the Expanded Hepatitis B vaccination strategy. One-way sensitivity analysis also provided that the current vaccine coverage was dominated for an increase in the risk of infection among unvaccinated individuals.Conclusion Increasing current vaccine coverage from 14% to no less than 80% across Ethiopian healthcare workforces would be the most cost-effective strategy.