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The cost‐effectiveness of hepatitis A vaccination in patients with chronic hepatitis C
Author(s) -
Myers Robert P.,
Gregor James C.,
Marotta Paul J.
Publication year - 2000
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1053/he.2000.5719
Subject(s) - medicine , vaccination , case fatality rate , hepatitis a vaccine , incidence (geometry) , hepatitis a virus , hepatitis a , chronic hepatitis , immunology , pediatrics , virus , hepatitis , epidemiology , physics , optics
Infection with hepatitis A virus (HAV) occasionally leads to acute liver failure and has a higher fatality rate in patients with chronic hepatitis C virus (HCV). Vaccination of patients with HCV against HAV is effective and well tolerated. This study examines the cost‐effectiveness of HAV vaccination in North American patients with chronic HCV. A decision analysis model was constructed to compare 3 HAV vaccination strategies in adult patients with chronic HCV over a period of 5 years: (1) vaccinate no patients ( treat none ); (2) vaccinate only susceptible (anti‐HAV negative) patients ( selective ); or (3) vaccinate all patients without prior testing of immune status ( universal ). Probabilities and direct costs were estimated from hospital data and the literature. The cost per patient for the 3 vaccination strategies were: treat none, $2.00; selective, $56.00; and universal, $82.00. For every 1,000,000 patients with HCV vaccinated over a 5‐year period, the selective strategy prevented 128 symptomatic cases of HAV, 3 liver transplantations, and 3 deaths owing directly to HAV compared with the treat none strategy. In addition, the selective strategy costs an additional $427,000 per patient with HAV prevented, and $23 million per HAV‐related death averted, compared with the treat none strategy. The results were most sensitive to the incidence of HAV infection; vaccination increased costs if the annual rate of infection was less than 0.56% (baseline, 0.01%). Vaccination of North American patients with chronic HCV against HAV infection is not a cost‐effective therapy.