OBJECTIVES: World Health Organisation (WHO) recommends vaccinating infants against hepatitis B starting from the birth dose. Finland is among rare countries implementing hepatitis B vaccination programme targeted at risk groups only. In Finland, reasons for the targeted approach have included very low prevalence of hepatitis B with uneven distribution of risk and prioritising antenatal hepatitis B screening as a means of hepatitis B prevention. We aimed to evaluate the cost-effectiveness of infant hepatitis B vaccination programme in Finland.

METHODS: A Markov model was used for the economic evaluation performed from a health care provider perspective. A 6-in-1 combination vaccine including the protection against hepatitis B was assumed to replace 5-in-1 vaccine currently used in the national vaccination programme. The hepatitis B incidence was based on the numbers of registered acute cases in National Infectious Disease Register (NIDR). The estimated incidence was adjusted for acute asymptomatic infections. The transition probabilities and the estimated QALY-losses related to the hepatitis B states of the model were primarily based on literature. Health state costs were primarily based on a previous register-based evaluation of hepatitis B-related health care costs in Finland. Discount rate for future costs and health effects was 3%. Main outcome measure was health care costs per quality adjusted life year (QALY) gained.

RESULTS: Hepatitis B-related disease burden in Finland is small. The cost-effectiveness results were sensitive to hepatitis B incidence, vaccine cost, and discount rate.

CONCLUSIONS: Offering hepatitis B vaccine as a part of the national vaccination programme is justifiable only with a small price difference between 5-valent and 6-valent combination vaccines. Targeting hepatitis B vaccination to close contacts of hepatitis B-infected individuals remains crucial also after the possible start of a universal infant vaccination programme.