 |
 |
|
Home |
Current Issue |
Past Issues |
In the Clinic |
ACP Journal Club |
CME |
Collections |
Audio/Video |
Mobile |
Subscribe |
Tools |
Help |
ACP Online
|
15 February 1993 | Volume 118 Issue 4 | Pages 298-306
Objective: To determine clinical and economic consequences of alternative vaccination strategies for preventing hepatitis B virus infection (HBV).
Methods: Decision analysis was used to evaluate costs, outcomes, and cost-effectiveness of three HBV management strategies ("no vaccination," "universal vaccination," and "screen and vaccinate") in four populations (newborns, 10-year-old adolescents, a high-risk adult population, and the general adult U.S. population). Information on HBV incidence and prevalence, clinical course, and management of acute illness and chronic sequelae was obtained from the literature and a panel of experts. Actual payments (costs) were obtained from Blue Cross/Blue Shield and local pharmacies. Incremental cost-effectiveness was calculated from the perspective of the payer of medical care and subjected to sensitivity analysis.
Results: Vaccination (with or without screening) prevents more disease at somewhat increased cost than no vaccination for the neonatal, adolescent, and adult populations. Vaccination (with or without screening) is a dominant strategy in adult high-risk populations (lower cost and greater benefit than no vaccination). Optimal cost-effectiveness, with nonmonetary benefits not discounted, results if all pregnant women are screened for active HBV infection, and HBV vaccine and hepatitis B immune globulin are administered to babies born to mothers with positive screening tests. Then HBV vaccine is administered to all children at age 10 and again 10 years later (incremental cost-per-year-of-life-saved relative to the "no vaccination" strategy is $375). A strategy of universal newborn vaccination alone leads to an incremental cost-per-year-of-life saved of $3332. If adolescents are vaccinated at age 10, incremental cost-per-year-of-life saved is $13 938; for the general adult population, the incremental cost-per-year-of-life saved of universal vaccination is $54 524. Discounting benefits will increase cost-per-year-of-life saved 7 to 12 times for all strategies.
Conclusions: HBV vaccine is most cost-effective when a strategy of screening newborns is combined with routine administration to 10-year-old children. The means to achieve substantial improvements in the health of the public in a cost-effective fashion are now available and should be pursued aggressively.
Author and Article Information
From the School of Dental Medicine, the School of Medicine, The Wharton School, and the Leonard Davis Institute of Health Economics, of the University of Pennsylvania, Philadelphia, Pennsylvania.
MEDICINE AND PUBLIC ISSUES
A Reappraisal of Hepatitis B Virus Vaccination Strategies Using Cost-Effectiveness Analysis
Requests for Reprints: Bernard S. Bloom, PhD, University of Pennsylvania, 2L Nursing Education Building, Philadelphia, PA 19104-6020.
Acknowledgments: The authors thank Drs. Martin Black (Chief, Liver Unit, Temple University School of Medicine); Gene Gibson (Associate Director, Pharmacy of the Hospital of the University of Pennsylvania), Mark Kane (E.I.S. Officer, Centers for Disease Control); Ray Koff (Chief of Medicine, Framingham Union Hospital); and Michael Scheld (Professor of Medicine, University of Virginia Health Sciences Center) for their participation in the expert panel.
Grant Support: By a grant from SmithKline Beecham.
Related articles in Annals:
This article has been cited by other articles:
|
|
 |
|
  L. Tilson, L. Thornton, D. O'Flanagan, H. Johnson, and M. Barry Cost effectiveness of hepatitis B vaccination strategies in Ireland: an economic evaluation Eur J Public Health, June 1, 2008; 18(3): 275 - 282. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. R. Ortega-Sanchez, G. M. Lee, R. J. Jacobs, L. A. Prosser, N.-A. Molinari, X. Zhang, W. B. Baine, M. M. McCauley, T. Miller, and for the Working Group on Leading Economic Issues f Projected Cost-effectiveness of New Vaccines for Adolescents in the United States Pediatrics, January 1, 2008; 121(Supplement_1): S63 - S78. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. W. Hutton, D. Tan, S. K. So, and M. L. Brandeau Cost-Effectiveness of Screening and Vaccinating Asian and Pacific Islander Adults for Hepatitis B Ann Intern Med, October 2, 2007; 147(7): 460 - 469. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. O. ElHassan, M. E. S. Sorbero, C. B. Hall, T. P. Stevens, and A. W. Dick Cost-effectiveness Analysis of Palivizumab in Premature Infants Without Chronic Lung Disease. Arch Pediatr Adolesc Med, October 1, 2006; 160(10): 1070 - 1076. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Lee, Y. Gong, J. Brok, E. H Boxall, and C. Gluud Effect of hepatitis B immunisation in newborn infants of mothers positive for hepatitis B surface antigen: systematic review and meta-analysis BMJ, February 11, 2006; 332(7537): 328 - 336. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Zhou, J. Santoli, M. L. Messonnier, H. R. Yusuf, A. Shefer, S. Y. Chu, L. Rodewald, and R. Harpaz Economic Evaluation of the 7-Vaccine Routine Childhood Immunization Schedule in the United States, 2001 Arch Pediatr Adolesc Med, December 1, 2005; 159(12): 1136 - 1144. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. P. Levaux, W. H. Schonfeld, J. M. Pellissier, W. M. Cassidy, S. K. Sheriff, and C. Fitzsimon Economic Evaluation of a 2-Dose Hepatitis B Vaccination Regimen for Adolescents Pediatrics, August 1, 2001; 108(2): 317 - 325. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. R. Luce, K. M. Zangwill, C. S. Palmer, P. M. Mendelman, L. Yan, M. C. Wolff, I. Cho, S. M. Marcy, D. Iacuzio, and R. B. Belshe Cost-Effectiveness Analysis of an Intranasal Influenza Vaccine for the Prevention of Influenza in Healthy Children Pediatrics, August 1, 2001; 108 (2): e24 - e24. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Jacobs, H. S. Margolis, and P. J. Coleman The Cost-effectiveness of Adolescent Hepatitis A Vaccination in States With the Highest Disease Rates Arch Pediatr Adolesc Med, August 1, 2000; 154(8): 763 - 770. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. L. Pierce, S. Smith, B. Rowe-West, and B. Sterritt Hepatitis B Maternal Screening, Infant Vaccination, and Infant Prophylaxis Practices in North Carolina Arch Pediatr Adolesc Med, June 1, 1999; 153(6): 619 - 623. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M. Fendrick, J. H. Lee, C. LaBarge, and H. A. Glick Clinical and Economic Impact of a Combination Haemophilus influenzae and Hepatitis B Vaccine: Estimating Cost-effectiveness Using Decision Analysis Arch Pediatr Adolesc Med, February 1, 1999; 153(2): 126 - 136. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. C. Wright and M. C. Weinstein Gains in Life Expectancy from Medical Interventions -- Standardizing Data on Outcomes N. Engl. J. Med., August 6, 1998; 339(6): 380 - 386. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Wiebe, P. Fergusson, D. Horne, M. Shanahan, A. Macdonald, L. Heise, and L. L. Roos Hepatitis B Immunization in a Low-incidence Province of Canada: Comparing Alternative Strategies Med Decis Making, October 1, 1997; 17(4): 472 - 482. [Abstract] [PDF]
|
|
|
|
 |
|
 N. Gitlin Hepatitis B: diagnosis, prevention, and treatment Clin. Chem., August 1, 1997; 43(8): 1500 - 1506. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. O. Tengs, G. Meyer, J. E. Siegel, J. S. Pliskin, J. D. Graham, and M. C. Weinstein Oregon's Medicaid Ranking and Cost- Effectiveness: Is There Any Relationship? Med Decis Making, June 1, 1996; 16(2): 99 - 107. [Abstract] [PDF]
|
|
|
|
 |
|
 H. J. Vosper Pediatric Immunization: Current Recommendations and Controversies Journal of Pharmacy Practice, February 1, 1996; 9(1): 14 - 26. [Abstract] [PDF]
|
|
|
|
|
|
J. Etchason, L. Petz, E. Keeler, L. Calhoun, S. Kleinman, C. Snider, A. Fink, and R. Brook The Cost Effectiveness of Preoperative Autologous Blood Donations N. Engl. J. Med., March 16, 1995; 332(11): 719 - 724. [Abstract] [Full Text] [PDF]
|
|
Article
