TABLE 1.
Key Input Variables and Ranges
| Variable | Base Case | Range | Distribution* | Reference |
|---|---|---|---|---|
| Age/birth cohort, y | ≥18 | 18–69 | ||
| Proportion of population (at an STI clinic), % | Hechter et al.6 | |||
| 18–24 y | 35 | |||
| 25–34 y | 39 | |||
| 35–44 y | 17 | |||
| 45–54 y | 7 | |||
| 55+ y | 3 | |||
| HBsAg prevalence in STI US population, % | 4.17 | Marseille et al.7 | ||
| Male-to-female ratio within the risk group, % | 61.9 | Pathela et al.8 | ||
| Ratio of prevalence in men vs. women | 1.38 | Patel et al.9 | ||
| Proportion with prior vaccination, % | ||||
| 18–29 y | 91.3 | 16–95 | Beta | Rosenthal et al.10† |
| 30–39 y | 40.1 | 37.0–91.3 | Beta | Lu et al.,11 CDC, 2021, unpublished |
| 40–49 y | 31.9 | 29.1–40.1 | Beta | Lu et al.,11 CDC, 2021, unpublished |
| 50–59 y | 24.9 | 22.6–31.9 | Beta | Lu et al.,11 CDC, 2021, unpublished |
| 60+ y | 15.6 | 14.3–24.9 | Beta | Lu et al.,11 CDC, 2021, unpublished |
| Proportion unvaccinated who have prior infection (anti-HBc positive regardless of anti-HBs), % | ||||
| 18–24 y | 8.8 | 4.2–13.3 | Beta | Trepka et al.48s |
| 25–34 y | 26.1 | 20.1–32.1 | Beta | Trepka et al.48s |
| 35+ y | 33.1 | 27.4–38.8 | Beta | Trepka et al.48s |
| Annual incidence of developing acute HBV infection, % | ||||
| 18–39 y | 1.0 | Beta | Miriti et al.4 | |
| 40+ y | 0.33 | Beta | Miriti et al.4 | |
| Percent not aware of their infection | 67 | 49–82 | Beta | Patel et al.9 |
| Percent aware of prior vaccination | ||||
| 19–49 y | 70 | 63.6–97.6 | Beta | Rolnick et al.12 |
| 50+ y | 80.8 | 75.5–86.2 | Beta | Rolnick et al.12 |
| Proportion adults diagnosed with CHB and linked to care and received antiviral treatment, % | 18 | 17–19 | Beta | Harris et al.41s |
| Screening costs, US$ | ||||
| Cost of hepatitis B serologic tests | CMS38s | |||
| HBsAg | 10.33 | 7.50–20.00 | Gamma | |
| Anti-HBc | 12.05 | 7.50–20.00 | Gamma | |
| Anti-HBs | 10.74 | 7.50–20.00 | Gamma | |
| All 3 hepatitis B tests | 28.27 | 25.00–40.00 | Gamma | |
| Vaccination costs, US$ | ||||
| Engerix-B/Recombivax HB private sector cost per dose | 61.54 | 25.43–73.85 | Gamma | CDC49s |
| Twinrix private sector cost per dose | 112.35 | 62.04–134.83 | Gamma | CDC49s |
| Heplisav-B private sector cost per dose | 121.25 | 73.05–145.50 | Gamma | CDC49s |
| Vaccine administration (physician) | 25.84 | 20.67–31.01 | Gamma | Tsai et al.50s |
| Vaccine administration (pharmacist) | 17.50 | 14–21 | Gamma | Tsai et al.50s |
| Patient time, vaccination-specific visit, physician's office, h | 2.00 | Ray et al.51s | ||
| Patient time, vaccination-specific visit, pharmacy, h | 0.20 | 0.17–0.29 | Gamma | Prosser et al.52s |
| Proportion of patients requiring vaccination-specific visit | ||||
| First dose | 0 | |||
| Second and third doses | 0.5 | 0–1 | Beta | CDC53s |
| Proportion of patients receiving vaccine in pharmacy setting | 0.3 | Singhal and Zhang15 | ||
| Mean hourly earnings, US$ | 29.96 | BLS54s | ||
| Linkage to care and treatment costs, US$ | ||||
| Antiviral drug costs per year | 502.00 | 326.00–1,464.00‡ | Gamma‡ | |
| Initial baseline tests (HBeAg, CBC, CMP, HBV DNA) | 71.40 | 35.70–107.10 | Gamma | CMS38s |
| Total annual monitoring costs‡ | 355.00 | 177.50–532.50 | Gamma | CMS38s |
| Clinic visit × 2 | 74.00 | § | CMS38s | |
| Ultrasound × 1 (50% none, 50% × 2) | 125.00 | § | CMS38s | |
| AFP × 1 (50% none, 50% × 2) | 17.00 | § | CMS38s | |
| CMP × 2 | 11.00 | § | CMS38s | |
| HBV DNA × 1 | 43.00 | § | CMS38s | |
| Annual disease management costs | ||||
| Medical costs, US$ | ||||
| CHB | 1694.00 | 183.00–5061.00 | Gamma | Liu et al.42s |
| Cirrhosis | 5057.00 | 183.00–5061.00 | Gamma | Liu et al.42s |
| Decompensated cirrhosis | 13,405.00 | 6709.00–20,115.00 | Gamma | Liu et al.42s |
| Hepatocellular carcinoma | 53,366.00 | 26,761.00–80,054.00 | Gamma | Liu et al.42s |
| Liver transplantation 1st year | 175,745.00 | 87,879.00–263,612.00 | Gamma | Liu et al.42s |
| Liver transplantation 2nd year | 30,687.00 | 15,343.00–46,043.00 | Gamma | Liu et al.42s |
| Acute symptomatic (not hospitalized) | 591.00 | 306.00–1029.00 | Gamma | Kim et al.61s |
| Acute symptomatic (hospitalized) | 17,340.00 | 3691.00–17,340.00 | Gamma | Kim et al.61s |
| Fulminant hepatitis | 27,707.00 | 27,791.00–74,414.00 | Gamma | Kim et al.61s |
| Patient and caregiver time costs, US$ | ||||
| Active HBV (w/o cirrhosis) | 5876.00 | 3289.00–8462.00 | Gamma | Federico et al.55s |
| Cirrhosis | 8639.00 | 6139.00–11,241.00 | Gamma | Federico et al.55s |
| HCC | 7816.00 | 5317.00–10,316.00 | Gamma | Federico et al.55s |
| Transplant | 16,440.00 | 13,940.00–18,940.00 | Gamma | Federico et al.55s |
| Sustained viral response | 960.00 | 0.00–7311.00 | Gamma | Assumption: 32 h/y |
| Health state utilities | ||||
| Immune state | 0.99 | 0.98–1.00 | Beta | Chahal et al.13 |
| Susceptible state | 0.99 | 0.98–1.00 | Beta | Chahal et al.13 |
| Active CHB | 0.91 | (0.80–0.92) | Beta | Woo et al.45s |
| Cirrhosis | 0.88 | (0.78–0.88) | Beta | Woo et al.45s |
| Inactive CHB | 1 | (0.90–1.00 | Woo et al.45s | |
| Decompensated cirrhosis | 0.73 | (0.49–0.82) | Beta | Woo et al.45s |
| Hepatocellular carcinoma | 0.81 | (0.77–0.85) | Beta | Woo et al.45s |
| Liver transplantation | 0.84 | (0.72–0.84) | Beta | Woo et al.45s |
| HBsAg seroclearance | 1 | (0.95–1.00) | Woo et al.45s | |
| Viral suppression | 1 | (0.95–1.00) | Woo et al.45s | |
| Vaccination, % | ||||
| Fraction receiving 1st dose | 74 | 66.6–81.4 | Beta | Miriti et al.4 |
| Fraction receiving 2nd dose (of those receiving 1st dose) | 61 | 47.7–62.7 | Beta | Bruxvoort et al.14 |
| Fraction receiving 3rd dose (of those receiving 1st dose) | 32 | 27.0–33.0 | Beta | Bruxvoort et al.14 |
| Seroprotection rate for Twinrix/Engerix-B/Recombivax HB (0-, 1-, and 6-mo schedule), % | ||||
| Vaccine effectiveness, 1st dose | ||||
| 18–29 y | 20.4 | 4–28.8 | Beta | Levie et al.56s |
| 30–39 y | 20.4 | 4–28.8 | Beta | Levie et al.56s |
| 40–49 y | 12 | 4–17.2 | Beta | Treadwell et al.57s |
| 50–59 y | 12 | 4–17.2 | Beta | Treadwell et al.57s |
| 60+ y | 7.5 | 4–8.6 | Beta | Joines et al.58s |
| Vaccine effectiveness, 2nd dose | ||||
| 18–29 y | 77.0 | 24–87.2 | Beta | Levie et al.56s |
| 30–39 y | 77.0 | 24–87.2 | Beta | Levie et al.56s |
| 40–49 y | 63 | 24–72.0 | Beta | Treadwell et al.57s |
| 50–59 y | 63 | 24–72.0 | Beta | Treadwell et al.57s |
| 60+ y | 50.4 | 24–60 | Beta | Joines et al.58s |
| Vaccine effectiveness, 3rd dose | ||||
| 18–29 y | 99.3 | 80–100 | Beta | Levie et al.56s |
| 30–39 y | 99.3 | 80–100 | Beta | Levie et al.56s |
| 40–49 y | 97 | 80–100 | Beta | Treadwell et al.57s |
| 50–59 y | 97 | 80–100 | Beta | Treadwell et al.57s |
| 60+ y | 92.2 | 80–100 | Beta | Joines et al.58s |
| Seroprotection rate for Heplisav-B (0- and 1-mo schedule), % | ||||
| Vaccine effectiveness, 1st dose | ||||
| 18–29 y | 22 | 12–32 | Beta | Hirst et al.59s |
| 30–39 y | 22 | 12–32 | Beta | Hirst et al.59s |
| 40–49 y | 22 | 12–32 | Beta | Hirst et al.59s |
| 50–59 y | 22 | 12–32 | Beta | Hirst et al.59s |
| 60+ y | 22 | 12–32 | Beta | Hirst et al.59s |
| Vaccine effectiveness, 2nd dose | ||||
| 18–29 y | 96 | 80–100 | Beta | Hirst et al.59s |
| 30–39 y | 96 | 80–100 | Beta | Hirst et al.59s |
| 40–49 y | 96 | 80–100 | Beta | Hirst et al.59s |
| 50–59 y | 96 | 80–100 | Beta | Hirst et al.59s |
| 60+ y | 96 | 80–100 | Beta | Hirst et al.59s |
| Discount rate, % | 3 | 0–5 |
*These are the distributions used for the probabilistic sensitivity analysis. The distributions are set such that the means are centered on the base-case value and the SDs of the distributions are set to match one-quarter of the ranges specified in the “Range” column of this table. Parameters with no distribution identified were not varied in probabilistic sensitivity analysis. More details are described in the Appendix (http://links.lww.com/OLQ/A809).
†The 2013 National Immunization Survey–Teen indicate that 91.3% of 17-year-olds received 3 doses of HepB vaccine in 2013.60s This coverage estimate of 17-year-olds from 2013 would be 25 years old in 2021, so we used this estimate for those aged 18 to 29 years of age for vaccination coverage.
‡The range of $326.00 to $16,464.00 is for 1-way sensitivity analysis, but for the probabilistic sensitivity analysis, an SD of 173 is used.
§Annual monitoring costs are implemented as a single parameter in the model. The subcomponents are shown to explain how the annual monitoring costs were calculated. However, for purposes of sensitivity analysis, only the total annual monitoring costs are varied.
All costs in 2021 US dollars, with inflation adjusting using the personal consumption expenditures index.
AFP indicates α-fetoprotein; HBc, hepatitis B core antibody; ALT, alanine aminotransferase; CBC, complete blood count; CHB, chronic hepatitis B; CMP, complete metabolic panel; HBeAg, hepatitis B e antigen; HBs, hepatitis B surface antibody; HBsAg, hepatitis B surface antigen; STI, sexually transmitted infections.