Cost‐effectiveness analysis of vaccination against hepatitis A in travellers

Abstract

Hepatitis A virus (HAV) infection is a substantial risk for travellers from low endemic countries to high endemic destinations. Costs and effects of alternative options for prevention were compared using formal decision analysis. General indications for the optimal prevention of hepatitis A were derived from a cost-effectiveness analysis. Various possible strategies for prevention of hepatitis A in travellers were compared to doing nothing: active immunisation using either the existing vaccine (HAVRIX 720) or the new vaccine (HAVRIX 1440); first screening for the presence of HAV antibodies and then vaccinating only susceptibles; and passive immunisation with immunoglobulin. Using a number of assumptions as baseline and for an average duration and frequency of travel from low to high endemic countries, threshold values were obtained for the choice between passive and active immunisation. Passive immunisation remains the most cost-effective prevention strategy for those expected to travel not more frequently than twice over the next 10 years and for short stays (7,000-9,000 pounds per infection prevented). For travellers expected to travel three or more times in 10 years or for trips exceeding a period of 6 months, active immunisation before the first trip is the most cost-effective option (7,500 pounds or less per infection prevented). When travel frequency increases to once a year in the next 10 years, costs per infection prevented decrease to about 3,500 pounds. Screening for the presence of antibodies before vaccination is only justified for older travellers or those leaving from countries with moderate endemicity, i.e., with an average HAV prevalence of at least 30%.

Cost-effectiveness analysis of hepatitis A vaccination strategies for adults

“…10,11 Several studies have examined the economic implications of vaccinating travelers, 10,12,13,14 military personnel, 15,16,17 hospital workers, 15 and children. 18 Studies on travel vaccination indicate that, for frequent travelers, vaccination is preferred whereas passive immunization is more cost-effective for those travelling less often and for shorter time periods.…”

The cost of hepatitis A infections in American adolescents and adults in 1997

“…Pre-exposure immunization with hepatitis A vaccine affords high levels of protection 33,34 that kinetic models suggest will persist for 20 years or longer. 35,36 Cost-effectiveness analyses support vaccination of certain high-risk populations, including travelers to developing countries, 4,5 homosexual men, 9 and children residing in communities with an annual incidence greater than 150 per 100,000. 6 Yet vaccination of high risk groups has minimal effects on national hepatitis A incidence.…”

“…These diverse techniques have often yielded conflicting estimates of hepatitis A treatment costs, ranging from $162 to $1,408 for outpatients and $1,540 to $4,157 for inpatients. [4][5][6][7][8][9] Several studies do not consider the higher costs of patients with fulminant disease, [6][7][8] and only 1 considers the relationship between age, severity, and treatment costs. 9 Work-loss costs resulting from hepatitis A infection are not considered by 2 studies, 4,5 yet are valued at $7,583 per case in another.…”

“…[4][5][6][7][8][9] Several studies do not consider the higher costs of patients with fulminant disease, [6][7][8] and only 1 considers the relationship between age, severity, and treatment costs. 9 Work-loss costs resulting from hepatitis A infection are not considered by 2 studies, 4,5 yet are valued at $7,583 per case in another. 7 One study assumes a total cost of $2,500 per case, including treatment, work loss, and health department activities, but these components were not presented separately.…”

An economic analysis of different strategies of immunization against hepatitis a virus in developed countries

“…Few cost-analysis studies establishing the cost-effectiveness of hepatitis A vaccination in the high-risk groups exist, 16,[25][26][27] but none of these studies attempt to study the cost-effectiveness of vaccination strategies that pursue widespread vaccination of the population in developed countries including a strategy of universal vaccination. The present study was performed with the purpose of assessing if mass immunization of young children against hepatitis A would also be cost-effective, because such an approach seems to be epidemiologically sound for achieving effective control and ultimate eradication of hepatitis A.…”