title: Should British soldiers be vaccinated against hepatitis A? An economic analysis.
abstract: We conducted a study to analyse the efficiency of introducing vaccination against hepatitis A to the schedule for troops in the British Army. The study design included a cost-effectiveness analysis (CEA) of cost per case avoided comparing active and passive immunization and a cost-benefit analysis (CBA). The study population comprised all British Army personnel as well as those soldiers assumed to be deployed to high-risk areas a variable number of times in 5 years. The average cost of one case of hepatitis A avoided by vaccination was calculated and compared with the average cost of achieving the same outcome by passive immunization. In a 5-year four-exposure scenario at a low incidence and using a 3% discount rate, avoiding one case of hepatitis A by vaccination would cost 52,865 pounds, against 97,305 pounds by passive immunization. The equivalent cost-benefit ratios are 13.4 for gammaglobulin and 7.2 for vaccine. For fewer exposures the break-even point for vaccine is two exposures in 4 years. Although our estimates are sensitive to direct costs and relatively sensitive to the estimated incidence, vaccinating troops against hepatitis A appears to be a more efficient procedure than passive immunization, especially as a long-term investment in troops likely to effect several operational deployments. Given the difficulty of forecasting which troops would deploy, the best-buy strategy may be vaccination of troops most likely to deploy repeatedly.
authors.affiliation: Headquarters British Army of the Rhine, London, UK.
authors.forename: T O
authors.initials: TO
authors.lastname: Jefferson
authors.forename: R H
authors.initials: RH
authors.lastname: Behrens
authors.forename: V
authors.initials: V
authors.lastname: Demicheli
mesh_terms: D003362:Cost-Benefit Analysis; D006506:Hepatitis A / Q000517:prevention & control*; D022362:Hepatitis A Vaccines; D006801:Humans; D007116:Immunization, Passive / Q000191:economics; D008889:Military Personnel; D006113:United Kingdom; D014611:Vaccination / Q000191:economics; D015164:Vaccines, Inactivated / Q000008:administration & dosage / Q000191:economics; D014761:Viral Hepatitis Vaccines / Q000008:administration & dosage* / Q000191:economics
chemical_list: D022362:Hepatitis A Vaccines; D015164:Vaccines, Inactivated; D014761:Viral Hepatitis Vaccines