An economic evaluation of universal infant vaccination against hepatitis B virus using a combination vaccine (Hib‐HepB): a decision analytic approach to cost effectiveness

Abstract

Objective : To evaluate the health impact and cost effectiveness of two infant vaccination strategies for protection against hepatitis B virus (HBV) infection in the Australian population. Vaccinating only high‐risk infants, assuming 65% compliance, was compared with universal vaccination of infants using a combination Hib‐HepB vaccine, with 87.4% compliance. Method : A Markov model simulated the natural history of HBV infection and disease in an Australian birth cohort. The cohort was divided into those at high risk of infection (infants born into high‐risk families) and low‐risk infants. Clinical and epidemiological data used were obtained from published reports and a survey of clinical experts. The model included the health costs associated with acute and chronic HBV infection, and the sequelae of chronic HBV infection. Results : The model predicted that universal hepatitis B vaccination of an Australian birth cohort (260,000 births) would result in a 77% reduction in cases of HBV infection. The incremental cost per life year gained was $11,862, which is low compared with many other health care interventions. With no discounting of costs or consequences, universal vaccination with the combination vaccine was predicted to save lives and reduce costs. Conclusion : There is no socially accepted threshold value for cost per life year gained to guide decisions about funding Australian health care interventions. Nevertheless, based on these results, universal hepatitis B vaccination of Australian infants using a combination Hib‐HepB vaccine would almost certainly be regarded as a worthwhile investment of public funds.

Effect of hepatitis B immunisation in newborn infants of mothers positive for hepatitis B surface antigen: systematic review and meta-analysis

“…The applicability of our findings to mothers negative for hepatitis B e antigen, which are of high proportions in, for example, the United States and northern Europe, is therefore limited 84. Cost effectiveness studies indicate that hepatitis B vaccination for infants of mothers positive for hepatitis B surface antigen are cost effective in countries with low,85 – 88 intermediate, and high prevalence 89 – 92. We identified no cost effectiveness studies assessing the effects of adding hepatitis B immunoglobulin to vaccine.…”

A survey of Sydney general practitioners' management of patients with chronic hepatitis B

“…Universal infant and pre-adolescent vaccination programs were considered, compared with a strategy of antenatal screening for hepatitis B surface antigen (HBsAg) followed by administration of hepatitis B immunoglobulin and hepatitis B vaccine to infants of HBsAg-positive 10 These results rate taken from Table 6 in the paper and differ from the results reported in the Abstract for the paper. Subsequently, Harris et al (2001) undertook a cost-effectiveness analysis of universal infant vaccination against HBV using a combination (Hib-HepB) vaccine compared with selective vaccination of high-risk infants using monovalent hepatitis B vaccine. They found that the incremental cost per life-year gained was $11,862 with discounting of costs and health outcomes.…”

Problem-Based Learning in Public Health Instruction: A Pilot Study of an Online Simulation as a Problem-Based Learning Approach

“…By modeling the body's physiological response to disease, injury and intervention, simulations allow students to practice clinical reasoning skills without putting an actual patient at risk. In the public health field, much of the literature focuses on simulations as applied decision support tools in areas such as screening strategies (Davies et al, 2002), smoking cessation (Levy et al, 2000;Kaplan et al, 2001), and immunization programs (Harris et al, 2001). Simulations have also been used successfully to model behavior change and the prevalence of chronic disease (Roberts, 2001).…”