Public health impact and cost effectiveness of routine childhood vaccination for hepatitis a in Jordan: a dynamic model approach

Abstract

BackgroundAs the socioeconomic conditions in Jordan have improved over recent decades the disease and economic burden of Hepatitis A has increased. The purpose of this study is to assess the potential health and economic impact of a two-dose hepatitis A vaccine program covering one-year old children in Jordan.MethodsWe adapted an age-structured population model of hepatitis A transmission dynamics to project the epidemiologic and economic impact of vaccinating one-year old children for 50 years in Jordan. The epidemiologic model was calibrated using local data on hepatitis A in Jordan. These data included seroprevalence and incidence data from the Jordan Ministry of Health as well as hospitalization data from King Abdullah University Hospital in Irbid, Jordan. We assumed 90% of all children would be vaccinated with the two-dose regimen by two years of age. The economic evaluation adopted a societal perspective and measured benefits using the quality-adjusted life-year (QALY).ResultsThe modeled vaccination program reduced the incidence of hepatitis A in Jordan by 99%, 50 years after its introduction. The model projected 4.26 million avoided hepatitis A infections, 1.42 million outpatient visits, 22,475 hospitalizations, 508 fulminant cases, 95 liver transplants, and 76 deaths over a 50 year time horizon. In addition, we found, over a 50 year time horizon, the vaccination program would gain 37,502 QALYs and save over $42.6 million in total costs. The vaccination program became cost-saving within 6 years of its introduction and was highly cost-effective during the first 5 years.ConclusionA vaccination program covering one-year old children is projected to be a cost-saving intervention that will significantly reduce the public health and economic burden of hepatitis A in Jordan.Electronic supplementary materialThe online version of this article (10.1186/s12879-018-3034-8) contains supplementary material, which is available to authorized users.

Tracking the Epidemiologic Shifts in Hepatitis A Sero-Prevalence Using Age Stratification: A Cross-Sectional Study at Jordan University Hospital

“…The conspicuous epidemiologic shift in HAV sero-prevalence with a decline in HAV IgG positivity in younger age groups was also reported in a review by Melhem et al in the MENA countries [36]. Thus, the observation of such a decline in this study appears as an expected result and puts a further emphasis on the possible benefit of HAV vaccination in Jordan [27]. This is particularly important in Jordan, considering the current instabilities in the region, which was accompanied by population displacements involving refugees settling in heavily populated camps with poor sanitation and access to clean drinking water [37][38][39].…”

Perspective and Costing in Cost-Effectiveness Analysis, 1974–2018

“…We found that 16 cost-per-QALY studies (1.4%) reported a total of 68 cost-per-QALY ratios from a healthcare sector and a societal perspective (34 ratios from each perspective), and five cost-per-DALY studies (0.7%) reported a total of 72 cost-per-DALY ratios (36 ratios from each perspective). Seven of 16 cost-per-QALY studies reported one ratio from each perspective [28][29][30][31][32][33][34], whereas two studies reported five and six intervention-specific ratios from each perspective, respectively [35,36]. Four of five cost-per-DALY studies reported one or two ratios from each perspective [37][38][39][40], and one multicountry study reported 31 ratios from each perspective [41].…”

Systematic Literature Review of Health Impact Assessments in Low and Middle-Income Countries

“…Studies reported that the use of quantitative methods in geographical settings where datasets were of weak quality called for adapted solutions. In our review, studies showed alternative avenues for impact modelling, for instance, to make up for the lack of incidence data [86,97]. In qualitative HIAs, different data collection methods were employed, including the use of participatory approaches such as stakeholder e-interviews [112], and news virtual tools such as Google Earth were applied [119].…”