An Economic Analysis of Different Strategies of Immunization Against Hepatitis A Virus in Developed Countries

Abstract

Acute hepatitis A is a major public health problem in developed countries, and because a large proportion of patients with acute hepatitis A do not have any identifiable risk factors, current practice of targeting the high-risk groups for vaccination against hepatitis A virus (HAV) is unlikely to have a significant impact on the overall incidence of acute hepatitis A. No economic analysis of strategies of mass immunization against HAV is available. Three different strategies of immunization against HAV using commercially available inactivated vaccine were compared in a Markov model analysis of a cohort of 2-year-old healthy children in a developed country. In strategy I, universal vaccination was pursued. In strategy II, children were initially screened for antibody and, if susceptible, they were vaccinated. In strategy III, no vaccination was offered. Cost per person and quality adjusted life-years (QALY) gained in each strategy were the outcome measures compared. The baseline analysis showed that strategy II is more costeffective than strategy I, with marginal cost-effectiveness ratios of $7,267.67 and $12,833.34, respectively, compared with a strategy of no intervention. Sensitivity analysis showed that if the cost of the two-dose vaccine could be reduced to less than $57, the strategy of universal vaccination would be the preferred immunization strategy. Different strategies of mass immunization against HAV in the developed countries are cost-effective by current standards of health care interventions and should be considered for incorporation into current childhood immunization programs. (HEPATOLOGY 1999;29:548-552.)

Cost-effectiveness of childhood hepatitis A vaccination in Argentina: a second dose is warranted

“…Fourth, we did not consider reduced life expectancy and quality of life for persons receiving hepatitis A liver transplants. Fifth, we assumed overt hepatitis A causes the loss of 0.06 QALYs per case (43), while other studies assume 0.08 to 0.22 QALYs are lost per case (48,49). Sixth, we may have underestimated disease rates.…”

“…The cost-effectiveness of a second vaccine dose at age 18 months ranges from US$ 159 to US$ 1 038 per QALY gained, or from 4% to 27% of Argentina's per-capita GDP. Other costeffectiveness assessments of hepatitis A vaccination have made more pessimistic assumptions regarding duration of protection (17,49). Had they been used in the current analysis, second dose cost-effectiveness would appear substantially improved.…”

Prevenção das hepatites virais através de imunização

“…One the one hand, in the highly endemic regions, it is almost impracticable to identify the groups at risk for acquiring the disease; and on the other, the high cost of vaccine makes it difficult to extend this benefit to the entire population. [45][46][47] Israel was the first country to adopt universal vaccination for children at 18 and 24 months of age in June 1999, and the results were excellent. 48 A very recent analysis of the impact of this program, 5.5 years after it began, reveals that an important decline has been observed in the incidence of the disease in all age groups, with 90%…”

“…49 Children at pre-school age must be the main focus of immunization strategies, because of their critical role in virus transmission. 21, [45][46][47]50 As has been demonstrated by different studies, the efficient way to diminish incidence of the disease and even eradicate the infection is mass vaccination of children. There are, however, many barriers to this measure being adopted, among them: the growing number of vaccinations in childhood, other public health priorities, the cost of vaccine and the reduced number of cost-effectiveness studies of this strategy for our country.…”

An individual-based model of hepatitis A transmission

“…Nevertheless, viral hepatitis A represents an important public health issue, imposing a remarkable economic burden worldwide (Berge et al, 2000;Das, 2003) and in Italy as well (Lucioni et al, 1998).…”