An Economic Evaluation of Hepatitis A Vaccination in Dutch Military Personnel

Abstract

We analyzed the cost-effectiveness of hepatitis A vaccination regimens using a mathematical simulation model. Passive immunization and two active vaccination strategies (with and without prior screening) were compared with "doing nothing." Hepatitis A antibodies were determined in 2,325 Dutch marines; other input data were retrieved from published and unpublished sources. The prevalence of hepatitis A antibody was 14%. Screening before vaccination was identified as appropriate at a prevalence > 20%. Passive immunization was the cheapest prevention for a single 6-month deployment per 10 years. The inactivated vaccine containing 1,440 enzyme-linked immunosorbent assay units without prior screening was identified as the best option for more frequent deployments. It was cost-saving with two or more missions per 10 years. A 5.3% hepatitis A attack rate validated the investment for this policy. Overall, immunization with inactivated hepatitis A vaccine without prior screening proved to be the optimum strategy for troops at regular risk.

Cost-effectiveness of hepatitis A vaccination in Indonesia

“…29 From the World Bank's report 30 in 2006 on economic impacts of sanitation in Indonesia and considering the annual incidence of HAV infection declining linearly at an average annual rate of 2% as the result of socioeconomic Figure 3.Univariate sensitivity analysis from the societal perspective improvement, 13 we obtained the number of hepatitis A cases in 2012 (mild, moderate, severe, and fatal cases) by considering the morbidity and mortality rates of 0.3211% and 0.0003%. 30 We estimated the total number of severe cases by applying the ratio of hospitalization (severe) and outpatient visit (mild-moderate) at 11.8%:88.2% according to a study by Zhuang et al 13 For the number of severe cases in each age group, we applied data from a study on hepatitis A cases at one of biggest public hospitals in Indonesia during 2011.…”

“…30 We estimated the total number of severe cases by applying the ratio of hospitalization (severe) and outpatient visit (mild-moderate) at 11.8%:88.2% according to a study by Zhuang et al 13 For the number of severe cases in each age group, we applied data from a study on hepatitis A cases at one of biggest public hospitals in Indonesia during 2011. 31 Furthermore, we estimated that moderate cases would make up 37.5% and mild cases 62.5% from outpatient visit cases based on a study by Buma et al 29 Several data from previous studies related to the age-specific probabilities of symptomatic infection, 32 hospitalization rate, 31 and case fatality rate 13 were used to estimate mild-moderate, severe, and fatal cases in various age groups. For economic consequences, we only consider symptomatic infections since asymptomatic infections were assigned no costs and excluded from further follow-up for disease outcomes.…”

Increasing Incidence of Hepatitis A in Korean Adults

“…Hepatitis A vaccines are highly effective in preventing hepatitis A in individuals and in reducing community outbreaks [23,24] . Epidemiological studies and economic evaluations of hepatitis A vaccination reported elsewhere in various risk groups, such as adolescents in Hong Kong [9] , health-care workers [25] , frequent travelers [26] or military personnel [27] , have suggested that vaccination is indeed cost-effective. However, recommendations for the use of hepatitis A vaccine vary considerably among different countries.…”

Cost-effectiveness of hepatitis A vaccination in children, adolescents, and adults

“…19 Economic analyses generally support these recommendations (Table 6), showing a degree of cost-effectiveness comparable with that of other vaccines in children living both in highly endemic areas of the United States and in the nation as a whole, 1,32,42 as well as cost-effectiveness well within accepted boundaries 28 for adolescents 31 and adults in several high-risk categories. 20,36,[38][39][40][46][47][48][49][50] Moreover, the combination vaccine for hepatitis A and hepatitis B may further improve the cost-effectiveness of vaccination programs. 42,69 In summary, this review of universal immunization against hepatitis A in children, adolescents, and high-risk adults in developed countries supports the cost-effectiveness of implementing ACIP recommendations regarding the use of these vaccines in the United States.…”

“…In the Dutch study, based on a Markov model, routine vaccination proved to be the most cost-effective strategy (vs. no vaccination, passive immunization with immunoglobulin, or immunization against hepatitis A only in serologically documented cases of susceptibility) for troops sent to an endemic area once every 3 years during a 10-year period. 47 The British study showed passive immunization to be less costly than routine vaccination only if one exposure to hepatitis A can be assumed; because of the uncertainty of deployment to widely dispersed geographical locations and the difficulty of achieving 100% coverage for a booster dose of immunoglobulin, routine vaccination was judged to be more desirable than passive immunization. 50 The Israeli study also noted that vaccination is more cost-effective than passive immunization for personnel serving long periods in endemic areas but not for those serving for short periods in low-endemic regions.…”