Mathematical Models of Hepatitis B Vaccination and Screening Programmes in the United Kingdom: A Systematic Review

PIN83 MatheMatIcal Models of hePatItIs B VaccINatIoN aNd screeNINg PrograMMes IN the UNIted KINgdoM: a systeMatIc reVIew Keeping S.T.1, Allen F.2, Patel A.2, Carroll S.M.1, Kilcoyne A.1 1Sanofi Pasteur MSD, Maidenhead, UK, 2Abacus International, Bicester, UK objeCtives: The United Kingdom (UK) has a targeted hepatitis B (HBV) vaccination programme for at-risk patient groups; however such a programme can be challenging to implement. The World Health Organisation (WHO) recommends universal HBV vaccination and this approach has been adopted by most developed countries. A systematic review was conducted to identify UK-based mathematical models for HBV to determine whether current evidence supports the use of a universal vaccination programme versus a targeted approach. Methods: Embase, Medline, Econlit and The Cochrane Library were searched for studies reporting HBV mathematical models (economic or epidemiological) in the UK population. Hand searching of Health Protection Agency and National Institute for Health and Clinical Excellence guidance documents was also performed. Economic models (cost-effectiveness, cost-utility, cost-benefit, cost-consequence) were included if they assessed HBV vaccination or screening programmes. Epidemiological studies were included if they modelled HBV immunity and infection rates. Data were independently extracted and summarised into evidence tables by two reviewers and quality appraisal of included studies was performed. Results: Electronic database searches identified a total of 649 citations resulting in 11 relevant publications. Hand searching yielded an additional two publications; a total of 13 included publications representing seven economic evaluations and six epidemiological modelling studies. Overall, there was considerable variation in model methodologies including methods of discounting used, static versus dynamic approaches and sources of model inputs. Only one epidemiological modelling study considered HBV transmission patterns across the UK. ConClusions: Current HBV vaccination policy in the UK is dependent on the demonstration of cost-effectiveness. However, this review highlights some of the limitations inherent in the models which have been used to support policy decisions. Alternative modelling approaches, as well as new data on key inputs, are desirable if the full value of a universal HBV vaccination programme in the UK is to be assessed.