Cost-effectiveness of the hepatitis B birth-dose vaccine in South Africa: a mathematical modelling analysis

Summary: Background: In 2022, South Africa had an estimated hepatitis B prevalence of 4·7–6·0%. In an effort to eliminate viral hepatitis as a public health threat, a targeted (ie, selective) hepatitis B birth-dose vaccination (HepB-BD) policy was introduced in 2023. Under this policy, only infants born to mothers with confirmed hepatitis B positivity are eligible for HepB-BD, which is given in addition to peripartum antiviral prophylaxis (PAP) for mothers from the second or third trimester of pregnancy. This policy differs from the WHO recommendation that all newborns should receive a HepB-BD vaccine (ie, a universal HepB-BD policy). We aimed to assess comparative costs and benefits of this and alternate policies in South Africa.