OBJECTIVES: In Myanmar, resource limitations, disparities in accessibility to antenatal care (ANC) and delivery by skilled birth attendants (SBA) between urban and rural influences newborns' accessibility to Hepatitis-B birth dose (HepB-BD) in preventing mother-to-child transmission of Hepatitis-B virus (MTCT of HBV). This study compares the potential cost-effectiveness of different HepB-BD vaccination strategies in urban and rural Myanmar.

METHODS: Economic evaluation using Decision Tree Model and secondary data analysis are done to calculate potential cost, effect, and cost-effectiveness of three HepB-BD vaccination strategies. Current practice provides HepB-BD vaccination mainly at large hospitals, resulting in low HepB-BD coverage. Strategy-A scales up HepB-BD vaccination by training pre-existing SBA and integrating HepB-BD vaccination to routine maternal and child health services. Strategy-B is designed by adding HBsAg screening among pregnant women during ANC by SBA to Strategy-A. This encourages institutional deliveries and increases HepB-BD coverage among high-risk newborns of HBV-infected pregnant women.

RESULTS: Comparing Strategy-A to current practice, incremental cost-effectiveness ratio (ICER) per neonatal HBV infection averted is USD 261 in urban and USD 505 in rural areas. Comparing Strategy-B to Strategy-A, ICER per neonatal HBV infection averted is USD 373 in urban and USD 201 in rural areas. Thus,it is cost-effective to scale up from current practice to Strategy-A, then to Strategy-B in urban areas if Myanmar's gross domestic product per capita (USD 1,527) is used as the cost-effectiveness threshold. However, extended dominance is detected for Strategy-A in rural areas. Robust one-way sensitivity analyses are conducted, but input parameters’ variation cannot change cost-effectiveness decisions despite significant ICER variations.

CONCLUSIONS: If adequate funding is available, it is cost-effective to implement Strategy-B in rural and urban Myanmar. If not, combining Strategy-B and current practice is recommended in rural areas, and Strategy-A is recommended in urban areas for scaling-up HepB-BD vaccination in preventing MTCT of HBV in Myanmar.