Two Dose HBV Vaccine Provides Protection, Cost Savings for Hospital Systems

Catherine Stevenson

When comparing a 3-dose hepatitis B virus (HBV) vaccine with a 2-dose version for healthcare professionals, the lesser dose version could yield significant cost savings while maintaining protection for hospital systems.

A team, led by Catherine Stevenson, Market Access and Policy, Dynavax Technologies, identified the health and economic impact of implemented a 2-dose HBV vaccine strategy in healthcare facilities compared to a 3-dose HBV vaccine.

Comparing the Vaccines

In recent years, many healthcare facilities have implemented preemptive vaccination programs to reduce HBV exposure to patients and healthcare professionals. However, there is a percentage of healthcare workers unprotected, particularly those first entering a healthcare system and those undergoing professional training.

First-generation immunizations for HBV require the completion of 3 doses of vaccine over a 6-month time period for maximum immunogenicity.

On the other hand HepB-CpG is a 2-dose vaccine used in the US since 2017, which includes rapid seroprotection over a 1-month interval.

The 2-dose version provides more immediate protection against HBV and has shown the ability to induce earlier and significantly higher seroprotection rates for health adults aged 18-70 years when compared to the 3-dose version.

“Thus, HepB-CpG may represent a potent tool for health systems by offering rapid HBV protection for HCPs, especially among those newly entering the system and at high risk of infection,” the authors wrote.

Testing It at a Hospital

The investigators targeted 1910 healthcare professionals newly entering a healthcare system over a 1-year period. They used a model that leverages seroprotection rates, which accounts for healthcare professionals vaccine compliance and seroprotection rates for different dosing regimens. The team also considered current pricing for postexposure prophylaxis treatment.

Each unprotected healthcare professional were vaccinated with either vaccine at month 0 and the investigators estimated a 3% monthly risk of exposure to HBV based on available data.

The investigators sought main outcomes of the number of healthcare professionals protected against HBV, the number of healthcare professionals potentially exposed to HBV, and the cost of postexposure prophylaxis among healthcare professionals requiring intervention.

Results

Following completion of the 2-dose vaccine, 1725 newly entered healthcare professionals were protected against HBV, which represents a 77% increase in protection when compared to the second dose of the 3-dose vaccine schedule. The HepB-CpG vaccine would also protect an additional 24% of newly entered healthcare professionals on series completion compared to the 3-dose vaccine.

If a hospital system were to utilize the 3-dose vaccine, 173 healthcare professionals who were unprotected would be potentially exposed to HBV and require intervention within 1-6 months of entry and 249 would be exposed to HBV throughout the entire 1 year period.

However, if they were to use the 2-dose vaccine, the estimated reduction in the first 1-6 months would be 51%, with an estimated 84 unprotected individuals exposed to HBV within 1-6 months and 115 exposed throughout the 1 year study.

There was an overall reduction of risk for unprotected healthcare professions of 54% if the 2-dose vaccine is used compared to the 3-dose version.

“Compared with the 3-dose vaccine, HepB-CpG was anticipated to provide faster, increased protection against HBV infection among newly entered HCPs,” the authors wrote. “In protecting a greater percentage of HCPs, HepB-CpG was also projected to substantially reduce the risk of HBV exposure.”

In addition, the economics show HepB-CpG would ultimately reduce the costs of postexposure prophylaxis treatment compared to the 3-dose vaccine. For the 1 year study period, the hospital system that implements the 3-dose vaccine would spend approximately $100,000 on prophylaxis, compared to $63,000 for the hospital that uses HepB-CpG.

There are approximately 248 million patients with chronic HBV globally, 840,000 of which live in the US.

The study, “Preventing hepatitis B virus infection among healthcare professionals: potential impact of a 2-dose versus 3-dose vaccine,” was published online in Human Vaccines & Immunotherapeutics.