{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T21:31:44Z","timestamp":1790285504645,"version":"4.1.0"},"reference-count":30,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,17]],"date-time":"2026-01-17T00:00:00Z","timestamp":1768608000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Beijing High-Level Innovation and Entrepreneurship Talent Support Program-leading talent projects","award":["G202513070"],"award-info":[{"award-number":["G202513070"]}]},{"name":"Beijing High-Level Innovation and Entrepreneurship Talent Support Program young backbone talent projects","award":["G202533321"],"award-info":[{"award-number":["G202533321"]}]},{"name":"Key Research Projects of Beijing Natural Science Foundation-Haidian District Joint Fund","award":["L242053"],"award-info":[{"award-number":["L242053"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Background: Hand, foot, and mouth disease (HFMD) remains a major public-health concern in China. While the monovalent EV-A71 vaccine has effectively reduced EV-A71\u2013associated cases, it offers no protection against CV-A16. The introduction of a bivalent EV-A71\/CV-A16 vaccine may offer broader protection, but its economic viability under different immunization strategies remains uncertain. Methods: We developed a dynamic transmission model integrated with cost-effectiveness analysis to assess the epidemiological and economic impact of a hypothetical bivalent EV-A71\/CV-A16 vaccine in China. Based on the immunization program policy, seven vaccination strategies, vaccine effectiveness (VE) levels ranging from 50\u201395% against EV-A71\/CV-A16, and coverage levels from 0\u201395% were evaluated. The threshold vaccine price (TVP) was derived based on incremental cost-effectiveness ratio (ICER) calculations. Cost-effectiveness was assessed using willingness-to-pay (WTP) thresholds defined as 1\u20133 times the gross domestic product (GDP) per capita. Results: The mean cost of two doses of the monovalent EV-A71 vaccine was USD133.0 (95% CI: 126.9\u2013139.1). Strategy 2, which targeted individuals unvaccinated with the monovalent EV-A71 vaccine, demonstrated the most favorable cost-effectiveness. At 45% coverage and 85% vaccine effectiveness, the estimated threshold price per dose was USD 107.7 (95% CI: 103.4\u2013112.0), with threshold vaccine prices increasing as coverage declined. When vaccination coverage exceeded 80%, the threshold vaccine price decreased substantially, falling below USD 45.9 (95% CI: 43.5\u201348.3) per dose. Conclusions: Large-scale inclusion in the national immunization program may not be economically justified at current cost levels. Targeted voluntary vaccination of unvaccinated, susceptible populations represents a more cost-effective and practical strategy during the early stage of vaccine introduction.<\/jats:p>","DOI":"10.3390\/vaccines14010091","type":"journal-article","created":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T09:24:34Z","timestamp":1768901074000},"page":"91","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cost-Effectiveness Analysis of a Bivalent Vaccine for Hand, Foot, and Mouth Disease: A Simulation-Based Study in Beijing, China"],"prefix":"10.3390","volume":"14","author":[{"given":"Mengyao","family":"Li","sequence":"first","affiliation":[{"name":"Beijing Key Laboratory of Surveillance, Early Warning and Pathogen Research on Emerging Infectious Diseases, Beijing Center for Disease Prevention and Control, Beijing 100013, China"},{"name":"School of Public Health, Capital Medical University, Beijing 100069, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Shen","sequence":"additional","affiliation":[{"name":"Beijing Key Laboratory of Surveillance, Early Warning and Pathogen Research on Emerging Infectious Diseases, Beijing Center for Disease Prevention and Control, Beijing 100013, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yonghong","family":"Liu","sequence":"additional","affiliation":[{"name":"Beijing Key Laboratory of Surveillance, Early Warning and Pathogen Research on Emerging Infectious Diseases, Beijing Center for Disease Prevention and Control, Beijing 100013, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Yao","sequence":"additional","affiliation":[{"name":"Beijing Key Laboratory of Surveillance, Early Warning and Pathogen Research on Emerging Infectious Diseases, Beijing Center for Disease Prevention and Control, Beijing 100013, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhuowei","family":"Luo","sequence":"additional","affiliation":[{"name":"Beijing Key Laboratory of Surveillance, Early Warning and Pathogen Research on Emerging Infectious Diseases, Beijing Center for Disease Prevention and Control, Beijing 100013, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Da","family":"Huo","sequence":"additional","affiliation":[{"name":"Beijing Key Laboratory of Surveillance, Early Warning and Pathogen Research on Emerging Infectious Diseases, Beijing Center for Disease Prevention and Control, Beijing 100013, China"},{"name":"School of Public Health, Capital Medical University, Beijing 100069, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiang","family":"Xu","sequence":"additional","affiliation":[{"name":"Beijing Key Laboratory of Surveillance, Early Warning and Pathogen Research on Emerging Infectious Diseases, Beijing Center for Disease Prevention and Control, Beijing 100013, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenhui","family":"Zhu","sequence":"additional","affiliation":[{"name":"School of Public Health, Peking University, Beijing 100191, China"},{"name":"China Center for Health Development Studies, Peking University, Beijing 100084, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuaibing","family":"Dong","sequence":"additional","affiliation":[{"name":"Beijing Key Laboratory of Surveillance, Early Warning and Pathogen Research on Emerging Infectious Diseases, Beijing Center for Disease Prevention and Control, Beijing 100013, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Jia","sequence":"additional","affiliation":[{"name":"Beijing Key Laboratory of Surveillance, Early Warning and Pathogen Research on Emerging Infectious Diseases, Beijing Center for Disease Prevention and Control, Beijing 100013, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renqing","family":"Li","sequence":"additional","affiliation":[{"name":"Beijing Key Laboratory of Surveillance, Early Warning and Pathogen Research on Emerging Infectious Diseases, Beijing Center for Disease Prevention and Control, Beijing 100013, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bingyi","family":"Yang","sequence":"additional","affiliation":[{"name":"WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoli","family":"Wang","sequence":"additional","affiliation":[{"name":"Beijing Key Laboratory of Surveillance, Early Warning and Pathogen Research on Emerging Infectious Diseases, Beijing Center for Disease Prevention and Control, Beijing 100013, China"},{"name":"School of Public Health, Capital Medical University, Beijing 100069, China"},{"name":"Public Health Emergency Management Innovation Center, Beijing 100013, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1007\/s10096-018-3206-x","article-title":"Hand, foot and mouth disease: Current knowledge on clinical manifestations, epidemiology, aetiology and prevention","volume":"37","author":"Esposito","year":"2018","journal-title":"Eur. 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