Prevention of hepatitis B virus transmission by immunization. An economic analysis of current recommendations.
OBJECTIVE
To evaluate the outcome of immunization strategies to prevent hepatitis B virus (HBV) transmission.


METHODS
A decision model was used to determine the incremental effects of the following hepatitis B immunization strategies in a birth cohort receiving immunization services in the public sector: (1) prevention of perinatal HBV infection, (2) routine infant vaccination, or (3) routine adolescent vaccination.


METHODS
Over the lifetime of the cohort, the reduction in infections and medical and work-loss costs of HBV-related liver disease were determined for each strategy and compared with the outcome without immunization.


RESULTS
Prevention of perinatal infection and routine infant vaccination would lower the 4.8% lifetime risk of HBV infection by at least 68%, compared with a 45% reduction for adolescent vaccination. From a societal perspective, each strategy was found to be cost saving, but was not cost saving with respect to direct medical costs. The estimated cost per year of life saved was $164 to prevent perinatal HBV infection, $1522 for infant vaccination, and $3730 for adolescent vaccination.


CONCLUSIONS
Routine vaccination of infants in successive birth cohorts to prevent HBV transmission is cost-effective over a wide range of assumptions. While economically less attractive than infant vaccination, adolescent vaccination could serve to protect those children who were not vaccinated as infants.
Margolis
H S
HS
Hepatitis Branch (A-33), Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Coleman
P J
PJ
Brown
R E
RE
Mast
E E
EE
Sheingold
S H
SH
Arevalo
J A
JA
D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D003663:Decision Trees; D005260:Female; D006509:Hepatitis B / Q000191:economics / Q000517:prevention & control* / Q000635:transmission; D017325:Hepatitis B Vaccines / Q000008:administration & dosage* / Q000191:economics; D006801:Humans; D017589:Immunization Programs / Q000191:economics*; D007115:Immunization Schedule; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D008297:Male; D011247:Pregnancy; D015397:Program Evaluation; D012307:Risk Factors; D014481:United States; D014611:Vaccination / Q000191:economics / Q000592:standards*
D017325:Hepatitis B Vaccines