Economic evaluation of hepatitis A vaccines by income level of the country: A systematic review

Abstract

Background & objectives: Although several reviews of economic evaluation (EE) studies on hepatitis A virus (HAV) vaccine exist, there remains a need to corroborate such data from time to time. This study aimed to systematically review the literature for reports on EE of HAV vaccination by type of population, characteristics of intervention and income level of the country. Methods: PubMed and Scopus were searched to identify relevant studies from inception up to May 2021 using topic-specific key words in various combinaiton. Full EE studies comparing HAV vaccination to no vaccine or immunoglobulin were included. The risk of bias was assessed by using the ECOBIAS checklist. Results: Among the 1984 identified studies, 43 were found eligible. Of these, 27 were from high-income countries (HICs), 15 from middle-income countries (MICs), and one from low income country. Majority of the studies used Markov model and/or decision tree (n=26). Eight studies used a dynamic model. The discount rate, perspective and time horizon varied across the studies. Universal HAV vaccination without screening was cost-effective among children (14/16, 87.5%) and adolescents (1/5, 20%) but not in adults (0/4, 0%). Analysis by the level of income found that universal HAV vaccination among children without screening was cost-effective in 81.8 per cent of the studies conducted in MICs (9/11) as compared to 66.7 per cent in HICs (4/6). About one-third of the studies conducted among children found that screening and HAV vaccination were cost-effective compared to no vaccination. Interpretation & conclusions: The finding of this review suggest that universal vaccination of children without screening was likely to be cost-effective, especially in MICs. Nevertheless, it should be noted that the methodology varied across studies. Several aspects should also be considered in transferring the EE results across jurisdictions.

Cost-effective analysis of hepatitis A vaccination in Kerala state, India

“…It was highlighted that our results were similar to those of studies conducted in middle-income countries including countries in Asia region, which indicating that hepatitis A vaccination among children were likely to be cost-effective or even cost-saving [ 18 , 20 , 21 , 48 ]. The reason that our results was in line with the studies conducted in middle income countries including China and Indonesia is probably due to similar context related to endemicity of hepatitis A.…”

“…With improvement in living and economic condition over the past decades, HAV infection is shifting from early childhood to adolescence and young adulthood reflecting epidemiological transition of hepatitis A in Kerala state, India [ 9 , 49 ] resulting in an increased risk of getting hepatitis A infection [ 11 , 50 ]. Previous studies [ 48 , 51 ] as well as a recent systematic review [ 21 ] on economic evaluation of hepatitis A vaccination suggested that incidence of hepatitis A is one of the most influential factors in the cost-effectiveness of hepatitis A vaccination. In addition, our results were consistent with the WHO recommendations that vaccination against hepatitis A be integrated into the national immunization schedule for children aged ≥ 1 year on the basis of incidence of hepatitis A, change in endemicity from high to intermediate, and considering the cost-effectiveness of vaccination strategy [ 5 ].…”

“…Nevertheless, policy decision on such large-scale immunization program should be based on evidence-based information. Although previous published cost-effectiveness studies of hepatitis A vaccination suggested that hepatitis A vaccination is cost-effective in most developing countries [ 16 – 21 ], there is a lack of cost-effectiveness evidence of hepatitis A vaccination strategy to inform policy decision making in India. The present study was conducted to estimate the cost-effectiveness of various hepatitis A vaccination strategies compared to no vaccination among the population in Kerala state, India.…”