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Intramuscular administration of HBV vaccination has shown limited responsiveness and durability of seroprotection in dialysis patients. Intradermal (ID) HBV Sci-B-Vac vaccination with imiquimod (Toll-like receptor 7 agonist) pretreatment was reported to be safe and improve seroprotection. This study aimed to evaluate the cost-effectiveness of ID administration of HBV Sci-B-Vac with pre-treatment imiquimod cream in dialysis patients from the perspective of US healthcare providers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A lifetime Markov model was used to estimate outcomes in a hypothetical cohort of serologically negative dialysis patients with: (1) HBV Sci-B-Vac administered intradermally with pre-treatment imiquimod (IMQ) cream (IMQ\u2009+\u2009ID group), (2) HBV Sci-B-Vac by intradermal injection alone (ID group), and (3) HBV Sci-B-Vac by intramuscular injection alone (IM group). Main results included direct medical costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>QALYs in the IMQ\u2009+\u2009ID group (2.9763) were the highest, followed by the ID group (2.9751) and the IM group (2.9740). The ID group (more costly and totals less QALYs versus IMQ\u2009+\u2009ID) was strongly dominated by the IMQ\u2009+\u2009ID group, and was eliminated from the cost-effectiveness analysis. The ICER of the IMQ\u2009+\u2009ID group versus the IM group (17,032 USD\/QALY) was lower than the willingness-to-pay (WTP) threshold (50,000 USD\/QALY) and remained lower than the WTP threshold in the one-way sensitivity analysis. The probabilities of IMQ\u2009+\u2009ID, IM, and ID groups to be cost-effective at a WTP of 50,000 USD\/QALY were 85.06%, 14.86%, and 0.08%, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>ID administration of HBV Sci-B-Vac with pre-treatment IMQ cream in serologically negative dialysis patients was the cost-effective strategy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12962-025-00682-0","type":"journal-article","created":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T18:54:14Z","timestamp":1764701654000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Intradermal hepatitis B vaccination with imiquimod pretreatment in dialysis patients: a cost-effectiveness analysis"],"prefix":"10.1186","volume":"24","author":[{"given":"Yingcheng","family":"Wang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mingjun","family":"Rui","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joyce H. 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