title: Testing for antibody to hepatitis A to decrease the cost of hepatitis A prophylaxis with immune globulin or hepatitis A vaccines.
abstract: BACKGROUND
  The introduction of new vaccines to prevent hepatitis A infection raises the question of the cost of these vaccines relative to immune globulin when short-term protection against hepatitis A is required. Since the prevalence of hepatitis A antibodies (anti-HAV) in the US population increases rapidly with age, testing for anti-HAV may decrease the cost of vaccination programs.
  
  
  METHODS
  A cost-analysis model was developed that incorporates the cost of immune globulin or hepatitis A vaccine, the number of doses of vaccine, the cost of testing for anti-HAV in either commercial or public-sector laboratories, and the prevalence of anti-HAV in the general population by age.
  
  
  RESULTS
  In comparison with hepatitis A vaccines, with expected costs between $10 and $25 per dose, use of immune globulin for postexposure prophylaxis or preexposure short-term (< or = 6 months) prophylaxis is much less expensive for all age groups. Testing for anti-HAV does not significantly diminish the cost of immune globulin regimens. In contrast, if anti-HAV testing is performed in a public-sector laboratory at $10 per test, and hepatitis A vaccine costs $10 per dose, testing reduces vaccination costs in those 40 years of age or older for a two-dose vaccine regimen and in those 30 years of age or older for a three-dose regimen. At the other end of the spectrum, if vaccine costs $35 per dose, commercial testing for anti-HAV at $25 per person reduces the costs in those 30 years of age or older if either a two- or three-dose regimen is elected. However, vaccine savings are realized in those 10 years and older if public-sector testing is performed and three doses of vaccine at $35 per dose are utilized. In an intermediate scenario of public-sector testing and vaccines costing $25 per dose, the cost would also be reduced in those 30 years old or older.
  
  
  CONCLUSIONS
  Testing for anti-HAV in frequent travelers, international government, business, and volunteer workers, military personnel, etc, may be an effective means of decreasing costs of hepatitis A prevention.
authors.affiliation: Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, MD.
authors.forename: J P
authors.initials: JP
authors.lastname: Bryan
authors.forename: M
authors.initials: M
authors.lastname: Nelson
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005260:Female; D006506:Hepatitis A / Q000191:economics / Q000276:immunology* / Q000517:prevention & control; D022362:Hepatitis A Vaccines; D006508:Hepatitis Antibodies / Q000097:blood*; D006801:Humans; D007136:Immunoglobulins / Q000191:economics* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D014195:Travel / Q000191:economics; D014481:United States; D014761:Viral Hepatitis Vaccines / Q000191:economics*
chemical_list: D022362:Hepatitis A Vaccines; D006508:Hepatitis Antibodies; D007136:Immunoglobulins; D014761:Viral Hepatitis Vaccines