OBJECTIVES: This analysis estimates the cost-effectiveness of a novel 3-antigen hepatitis B vaccine approved in May 2022 for the prevention of hepatitis B virus (HBV) infection among UK adults.

METHODS: A combined decision tree and Markov model structure followed adults vaccinated with either a 3-dose 3-antigen or a 3-dose single-antigen vaccine over their remaining lifetimes. Adults aged 18-44,45-64 and ≥65 years were modeled, with subgroup analyses of diabetic and obese adults (≥18 years).

Seroprotection rates after each dose were taken from the pivotal, phase 3, head-to-head PROTECT trial (NCT03393754). Age-specific incidence from Public Health England (2020) was adjusted for underreporting. Age-specific, hepatitis B vaccine completion rates in the UK were used to estimate the number seroprotected under real-world conditions. Other model input values were obtained from published or publicly available UK sources. Total and incremental health and cost outcomes (2020 GBP) were discounted 3.5% annually and reported from the NHS perspective. One-way sensitivity and scenario analyses were conducted.

RESULTS: The 3-antigen vaccine resulted in fewer acute and chronic HBV infections, complications, and deaths when compared with the single antigen vaccine due to higher seroprotection rates and faster onset of seroprotection. For adults aged 18-44 years, vaccination with the 3-antigen vaccine was the dominant strategy, resulting in lower costs and more quality-adjusted life-years (QALYs) compared with single-antigen vaccine. The incremental cost effectiveness ratio (ICER) was £7,330 per QALY gained for adults aged 45-64 years and £75,602 for adults aged ≥ 65 years. Results were most sensitive to changes in vaccine acquisition cost and SPR rates. Subgroup analyses showed an ICER of £7,638 in obese adults and £58,769 in diabetic adults.

CONCLUSIONS: Vaccination with the 3-antigen vaccine has the potential to substantially improve health outcomes for adults and vulnerable populations and is a cost-effective, important new tool for the prevention of HBV.