This study evaluated the economic and health benefits of hepatitis E (HEV) screening and vaccination in both outbreak and sporadic settings in China. Decision-analytic Markov models were used to evaluate the population impact and cost-effectiveness of HEV screening and vaccination for people with chronic hepatitis B (CHB), older adults, pregnant women, and women of childbearing age. Simulations projected outcomes over six months for outbreak settings and lifetime horizons for sporadic settings. Incremental cost-effectiveness ratios (ICERs) were derived from a health system perspective with costs in 2023 US. Robustness was examined through sensitivity analyses. Preventive universal screening combined with standard 3-dose HEV 239 vaccine was cost-effective only for people with CHB (Incremental cost-effectiveness ratio ICER: 25. 38 thousand per Quality-Adjusted Life Year QALY gained), reducing symptomatic infections by 58. 16% and HEV-related deaths by 57. 51% in sporadic settings. This strategy may be economically viable for other vulnerable populations if the vaccine price is below 21 per dose. In outbreak settings, reactive universal screening combined with emergency 2-dose vaccination yielded cost-effective for older adults, pregnant women, and people with CHB (ICERs of 8. 80, 26. 26, and 31. 81 thousand per QALY gained), reducing symptomatic infections and HEV-related deaths by over 70% within six months. In China, where sporadic settings are more common, preventive universal HEV screening combined with standard 3-dose vaccination is cost-effective only for people with CHB. High vaccine costs render this strategy economically unfeasible for older adults, pregnant women, and women of childbearing age.
Liu et al. (2026) studied this question.