Regional variation in the cost effectiveness of childhood hepatitis A immunization

Abstract

Childhood hepatitis A vaccination is most cost-effective in areas with the highest incidence rates but would also meet accepted standards of economic efficiency in most of the US. A national immunization policy would prevent substantial morbidity and mortality, with cost effectiveness similar to that of other childhood immunizations.

Cost-effectiveness of childhood hepatitis A vaccination in Argentina: a second dose is warranted

“…Prior studies using the identical Markov model provide comparative information. In Chile, 7 100 vaccine doses are required to prevent one hepatitis A death (11), while in the United States, 39 900 doses are required (17). Since Argentina is the only country to implement childhood hepatitis A vaccination with a single dose, it is reasonable to consider whether the amount saved by withholding the second dose is worth the projected health consequences.…”

“…Some economic analyses consider net costs to the health system, i.e., excluding effects on work absenteeism. In the United States (17) and Chile (11), health system costs of a two-dose childhood hepatitis A schedule are US$ 9 100 and US$ 281 per QALY gained, respectively. Our model indicates that in Argentina, the one-dose, 12-month schedule would cost the health system < US$ 0 per QALY gained, while the two-dose 12-and 18-month schedule would cost US$ 12 per QALY gained.…”

“…A Markov model, previously described (11,17), was used to predict hepatitis A outcomes with and without vaccination. Markov models can be powerful tools for economic evaluation, since they allow both costs and outcomes to be predicted over extended time periods (23).…”

“…To estimate the number of infections from reported cases, two assumptions were made: (1) 100% of reported cases had overt illness; and (2) the proportions of infected individuals with overt illness are as follows: less than 5 years old, 7.0%; 5 to 9 years old, 37.0%; 10 to 14 years old, 71.0%; 15 to 49 years old, 75.7%; and 50 years and older, 86.0% (4,17). Under these assumptions, peak infection rates occurred between ages 2 and 4 years in each region (Table 1).…”

“…Kinetic models of antibody decline suggest vaccine-induced immunity will persist for decades after a two-dose series (14,15). Childhood vaccination is costeffective in many (11,(16)(17)(18)(19)(20) but not all countries (8,21). Cost-effectiveness is largely determined by the proportion of children with natural immunity and the ratio of vaccination-to-illness costs.…”