Hepatitis B immunization in a low-incidence province of Canada: comparing alternative strategies.
This study provides a comparative cost-effectiveness analysis of three universal immunization programs for hepatitis B virus (HBV). Using three theoretical cohorts of infants, 10-year-olds, and 12-year-olds, a universal immunization program was compared with a prenatal screening/newborn immunization program involving testing of prepartum women and immunization of newborns of HBsAg-positive mothers. A Markov long-term outcome model used Manitoba data to estimate costs and health outcomes across the lifespan. The model was based on an HBV incidence rate of 19/100,000 and a discount rate of 5% and incorporated the most recent treatment advances (interferon therapy). Cost-effectiveness was calculated as the ratio of dollars spent per year of life saved, with costs determined from the perspective of a third-party payer. The universal infant-immunization program, although not cost-saving, was associated with a low, economically attractive cost-effectiveness ratio of $15,900 (Canadian) per year of life saved, a figure substantially lower than the ratios of $97,600 and $184,800 (Canadian) associated with the universal programs for 10- and 12-year-olds, respectively. Cost-effectiveness ratios were found to be sensitive to changes in immunization costs, HBV incidence rates, and the rate at which protective antibody levels are lost over time: If these variables move in the directions suggested by current trends, the authors anticipate an increasing economic appeal of universal programs well into the future. A universal program of HBV immunization for infants appears to be economically practical in regions where HBV infection rates are low and stable.
Wiebe
T
T
Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
Fergusson
P
P
Horne
D
D
Shanahan
M
M
Macdonald
A
A
Heise
L
L
Roos
L L
LL
D006528:Carcinoma, Hepatocellular / Q000401:mortality; D002648:Child; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003663:Decision Trees; D005260:Female; D006509:Hepatitis B / Q000150:complications / Q000188:drug therapy / Q000276:immunology / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D017589:Immunization Programs / Q000191:economics*; D007223:Infant; D007231:Infant, Newborn; D007372:Interferons / Q000191:economics / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000401:mortality; D008350:Manitoba / Q000453:epidemiology; D008390:Markov Chains; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000191:economics*
D007372:Interferons