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Cost‐effectiveness analysis of hepatitis A vaccination strategies for adults
Author(s) -
O'Connor J. Barry,
Imperiale Thomas F.,
Singer Mendel E.
Publication year - 1999
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.510300422
Subject(s) - medicine , vaccination , cost effectiveness , hepatitis a , baseline (sea) , case fatality rate , hepatitis a vaccine , cost–benefit analysis , incidence (geometry) , hepatitis , environmental health , immunology , population , risk analysis (engineering) , mathematics , ecology , oceanography , geometry , biology , geology
Our objective in this study was to determine the cost‐effectiveness of hepatitis A vaccination strategies in healthy adults in the United States. We constructed a decision model simulating costs and health consequences for otherwise healthy adults with respect to hepatitis A prevention. Three strategies were compared: (1) no intervention, (2) vaccination against hepatitis A, and (3) testing for antibodies to hepatitis A and vaccinating those without antibodies. Costs and probabilities were obtained from the published literature. One‐ and two‐ way sensitivity analyses were performed. Under baseline conditions, the “test” strategy cost $230,100 per life‐year saved compared with the “no intervention” strategy. The incremental cost‐effectiveness of the “vaccination” strategy compared with the “test” strategy was $20.1 million per life‐year saved. The “test” strategy was cost‐effective when the hepatitis A case fatality rate exceeded 17% (baseline 2.7%). The “vaccination” strategy was cost‐effective when 1 dose of vaccine cost $7 or less (baseline $57). Under baseline conditions, neither the “test” nor the “vaccination” strategies are considered cost‐effective according to current standards. Large changes in hepatitis A incidence, mortality rates, or vaccine cost are required for either of the intervention strategies to approach potentially cost‐effectiveness. Such conditions may occur in areas in which hepatitis A is endemic, and/or under mass‐vaccination scenarios.