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Objective To establish multistage Decision tree-Markov model of the hepatitis B immunization strategies for the people over 15 years old in China, and selected the best hepatitis B vaccination strategy for different groups of people. The study results can provide relevant departments with statistical basis for hepatitis B immunization strategies making.Methods The cost variables for HBV-infected were obtained from the investigation of the economic burden of hepatitis B-related diseases. The parameters of hepatitis B virus markers (HBVM) positive rate and positive rate of anti-HBs after vaccination were got through the Meta analysis. At the same time, other relevant factors were also considered, such as vaccination coverage, the new infection rate of hepatitis B vaccine, vaccination costs, screening costs, the discount rate, the conversion rate after HBV infection. Build multistage Decision tree-Markov model of the hepatitis B immunization strategies for the people over 15 years old in China by TreeAge Pro 2009 decision analysis software, and then finish cost-benefit analysis by TreeAge 2009 software. We used benefit-cost (BCR) to select the best hepatitis B vaccination strategy for different groups of people. We adopted sensitivity analysis to explore the main influencing factors on the best vaccination strategy.Results 1. The strategy of immunization of hepatitis B for people over the age of 15 is that selective vaccination is better than universal vaccination, and the BCR of selective vaccination was greater than 1, the BCR of universal vaccination less than 1.2. The optimizing immunization strategy for people of over 15 years is inoculating three 10μg vaccines after screening the markers anti-HBs, HBsAg and HBc according the program of 0,1 and 6 months. BCR of the optimizing strategy of age group 15-19 years is 2.40, and cost is 1229.59 RMB, benefit is 2950.75 RMB, net benefit is 1721.16 RMB. BCR of the optimizing strategy of age group 20-29 years is 3.22, and cost is 862.56 RMB, benefit is 2774.04 RMB, net benefit is 1911.49 RMB. BCR of the optimizing strategy of age group 30-39 years is 3.81, and cost is 680.09 RMB, benefit is 2591.16 RMB, net benefit is 1191.07 RMB. BCR of the optimizing strategy of age group 40-49 years is 3.98, and cost is 5421.81 RMB, benefit is 2157.92 RMB, net benefit is 1615.12 RMB. BCR of the optimizing strategy of age group over 50 years is 3.22, and cost is 290.16 RMB, benefit is 935.20 RMB, net benefit is 645.04 RMB. BCR of each age group increases with increasing age, but the benefit of each group decreases with increasing age. Those results suggest that investment in the lower age group will have greater social benefits.3. Decision tree-Markov model and cost-benefit analysis can comprehensive evaluate the hepatitis B immunization strategy, and choose the optimizing immunization strategy.4. The order of the sensitivity of the different parameters involved in the model:HBVM positive rate, the coverage of hepatitis B vaccine, rate of anti-HBs after vaccination, vaccine and vaccination fees, screening fees, discount rate and the costs of HBV-infected.5. The intangible cost of HBV-infected has not found the effect on the order of immunization strategy.Conclusion 1. The strategy of immunization of hepatitis B for people over the age of 15 is that selective vaccination is better than universal vaccination, and the optimizing immunization strategy for people of over 15 years was inoculate three 10μg vaccines after screening the markers anti-HBs, HBsAg and HBc according the program of 0,1 and 6 months.2. Decision tree-Markov model can comprehensive evaluate the hepatitis B immunization strategy, and has good applicability and reliability.3. Parameters of Greater impacting on the model are positive rate HBVM, the coverage of hepatitis B vaccine, rate of anti-HBs after vaccination. Vaccine and vaccination fees, screening fees, discount rate and the costs of HBV-infected have less affected on the model.4. The intangible cost of HBV-infected has not found the effect on the order of immunization strategy.
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