Cost-effectiveness of cytomegalovirus vaccination for females in China: A decision-analytical Markov study

Meng-Zhao Yin, Yuan-Yuan Gu, Jun-Tao Shu, Bin Zhang, Min Su, Lu-Ping Zhang*, Yin-Hua Jiang*, Gang Qin*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: The global burden of disease caused by congenital cytomegalovirus (CMV) infection is high. Previous modeling studies have suggested that CMV vaccination may be cost-effective in developed countries. Congenital CMV infection is more likely driven by maternal non-primary infection in China. We aimed to measure the effectiveness and cost-effectiveness of population-level CMV vaccination in Chinese females.

Methods: A decision tree Markov model was developed to simulate potential CMV vaccination strategies in a multi-cohort setting, with a population size of 1,000,000 each for the infant, adolescent (10-year-old) and young adult (20-year-old) cohorts. The hypothetical vaccines were assumed to have 50% efficacy, 20 years of protection, 70% coverage, at a price of US$120/dose for base-case analysis. Costs and disability-adjusted life years (DALYs) were discounted by 3% per year and the vaccination would be considered cost-effective if an incremental cost-effectiveness ratio (ICER) was lower than 2021 Chinese per capita GDP (US$12,500).

Findings: For the pre-infection (PRI) vaccine efficacy type, the adolescent strategy was the most cost-effective, with an ICER of US$12,213 (12,134 to 12,291) pre DALY averted, compared with the next best strategy (young adult strategy). For pre- and post-infection (P&PI) efficacy type, the young adult strategy was the most cost-effective as it was cost-saving. In one-way analysis varying the PRI vaccine price, the infant strategy, adolescent strategy and the young adult strategy would be a dominant strategy over others if the vaccine cost ≤US$60, US$61–121 and US$122–251 per dose respectively. In contrast, the young adult strategy continued to be the preferred strategy until the P&PI vaccine price exceeded US$226/dose. Our main results were robust under a wide variety of sensitivity analyses and scenario analyses.

Interpretation: CMV vaccination for females would be cost-effective and even cost-saving in China. Our findings had public health implications for control of CMV diseases.
Original languageEnglish
Pages (from-to)5825-5833
Number of pages9
Issue number40
Early online date12 Aug 2023
Publication statusPublished - 15 Sept 2023


  • Cost-effectiveness analysis
  • Cytomegalovirus
  • Decision tree
  • Markov model
  • Vaccine


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