Economic analysis of the first 20 years of universal hepatitis B vaccination program in Italy

Boccalini, Sara; Taddei, Cristina; Ceccherini, Vega; Bechini, Angela; Levi, Miriam; Bartolozzi, Dario; Bonanni, Paolo

doi:10.4161/hv.23827

Cited by 28 publications

(21 citation statements)

References 27 publications

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“…Indeed, the present findings and those of others have shown that vaccinating half of the at-risk population might have a positive impact on HBV incidence [30]. In the French setting in particular, we believe that the results of our study strongly suggest that proposing anti-HBV vaccination to unprotected individuals attending the CDAGs or similar healthcare facilities should be an efficient policy against HBV circulation [2,31,32].…”

Section: Discussionsupporting

confidence: 69%

Evolution of the incidence of hepatitis B virus infection and immunization rates in a large French cohort born between 1960 and 1994

Ramière

Roche

Scholtès

et al. 2016

Clinical Microbiology and Infection

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In France, several successive changes in anti-hepatitis B virus (HBV) vaccination policies occurred since 1982. We estimated the incidence and prevalence of HBV infection according to years of birth 1960 to 1994 in a large sentinel cohort to evaluate the epidemiology of HBV during vaccination policy changes. A retrospective cohort study included data from all HIV, HBV and hepatitis C virus (HCV) screening facilities in Grand Lyon. From 2005 to 2010, all 57113 individuals with complete HBV serologic status were enrolled. Survival analyses modeled separately various ages in each birth cohort. The proportion of immunized individuals increased in birth cohorts 1978 to 1984 (up to 58.3% (95% confidence interval (CI), 43.3-68.2 at age 15). In post-1985 birth cohorts, this proportion decreased to 19.5% (95% CI, 15.5-24) in birth cohort 1987 at age 15. Probability of past or current HBV infection increased constantly in birth cohorts 1960 to 1967, up to 12% (95% CI, 10.4-14) at age 30, then decreased gradually in birth cohorts 1968 to 1991, down to 0.9% (95% CI, 0.7-1.2) at age 17.5. In post-1991 cohorts, the probability of HBV infection increased again, up to 2.5% (95% CI, 1.7-3.6) at age 17.5. HBV incidence fluctuated between 5 and 8 per 1000 person-years in pre-1986 birth cohorts, decreased to 2.1 (95% CI, 1.5-2.7) in birth cohorts 1986 to 1991 but rebounded to 5 (95% CI, 3.5-7.1) in post-1991 birth cohorts. HBV incidence was remarkably high in young adults with noticeable variations concomitantly to vaccination policy changes. A dramatic decline in immunization rate was temporally associated with a sharp rebound of infection after withdrawal of systematic adolescent vaccination in 1998.

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Section: Discussionsupporting

confidence: 69%

Evolution of the incidence of hepatitis B virus infection and immunization rates in a large French cohort born between 1960 and 1994

Ramière

Roche

Scholtès

et al. 2016

Clinical Microbiology and Infection

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“… 63 Although attempting to quantify returns within a short timescale can be challenging, even larger returns on investment were seen over a 10–20 years time horizon. 10 15 17 32 58 This has significant implications for policymakers, who often work to a much shorter time horizon (typically 3–5 years). We suggest that Public Health England, NICE and other advisory bodies therefore need to routinely emphasise that public health interventions can offer surprisingly rapid returns, which may increase further over the longer term.…”

Section: Limitationsmentioning

confidence: 99%

Return on investment of public health interventions: a systematic review

Masters

Anwar

Collins

et al. 2017

J Epidemiol Community Health

307

210

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BackgroundPublic sector austerity measures in many high-income countries mean that public health budgets are reducing year on year. To help inform the potential impact of these proposed disinvestments in public health, we set out to determine the return on investment (ROI) from a range of existing public health interventions.MethodsWe conducted systematic searches on all relevant databases (including MEDLINE; EMBASE; CINAHL; AMED; PubMed, Cochrane and Scopus) to identify studies that calculated a ROI or cost-benefit ratio (CBR) for public health interventions in high-income countries.ResultsWe identified 2957 titles, and included 52 studies. The median ROI for public health interventions was 14.3 to 1, and median CBR was 8.3. The median ROI for all 29 local public health interventions was 4.1 to 1, and median CBR was 10.3. Even larger benefits were reported in 28 studies analysing nationwide public health interventions; the median ROI was 27.2, and median CBR was 17.5.ConclusionsThis systematic review suggests that local and national public health interventions are highly cost-saving. Cuts to public health budgets in high income countries therefore represent a false economy, and are likely to generate billions of pounds of additional costs to health services and the wider economy.

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“…A European review, taking the UK as an example, demonstrated that for every euro spent on targeted influenza vaccination for the elderly, €1.35 savings were generated in terms of reduced medical spending elsewhere ( 18 ) in the healthcare system. In Europe, an Italian study reported that universal hepatitis B childhood vaccination would have a positive economic impact 20 years after its implementation ( 19 ). The ROI was estimated to be almost 1 from the National Health Service perspective, and the BCR slightly less than 1 from the societal perspective, considering only the first 20 years after the start of the programme.…”

Section: Vaccination Represents a Valuable Investment In Health Withmentioning

confidence: 99%

“…With a longer term horizon, both the ROI and BCR values were estimated to be positive (2.78 and 2.47, respectively). The hepatitis B vaccination programme in Italy is a clear example of the massive impact that universal vaccination can have on the medium-to-long-term, when healthcare authorities are wise enough to invest in prevention ( 19 ).…”

Section: Vaccination Represents a Valuable Investment In Health Withmentioning

confidence: 99%

Vaccination: the cornerstone of an efficient healthcare system

Rémy

Zöllner

Heckmann

2015

Journal of Market Access & Health Policy

156

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Vaccination has made an important contribution to the decreased incidence of numerous infectious diseases and associated mortality. In 2013, it was estimated that 103 million cases of childhood diseases in the United States had been prevented by the use of vaccines since 1924. These health effects translate into positive economic results, as vaccination can provide significant savings by avoiding the direct and indirect costs associated with treating the disease and possible long-term disability. A recent US study estimated that every dollar spent on childhood vaccination could save US$3 from a payer perspective and US$10 from a societal perspective. The first vaccines set a high standard from a public health ‘return on investment’ perspective, because they are highly cost-saving. Today, however, where only a few healthcare interventions are considered to be cost-saving, the challenge that decision-makers typically face is to identify such healthcare interventions that are deemed cost-effective, that is, provide extra benefit at a reasonable extra cost. Some of the newer vaccines provide a solution to some of today's important health issues, such as cervical cancers with human papillomavirus vaccines, or debilitating diseases with herpes zoster vaccines. These recent, more expensive vaccines have been shown to be cost-effective in several economic analyses. Overall, vaccination can still be regarded as one of the most cost-effective healthcare interventions.

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Economic analysis of the first 20 years of universal hepatitis B vaccination program in Italy

Cited by 28 publications

References 27 publications

Evolution of the incidence of hepatitis B virus infection and immunization rates in a large French cohort born between 1960 and 1994

Evolution of the incidence of hepatitis B virus infection and immunization rates in a large French cohort born between 1960 and 1994

Return on investment of public health interventions: a systematic review

Vaccination: the cornerstone of an efficient healthcare system

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