title: Cost-effectiveness of hepatitis A vaccination in healthcare workers.
abstract: OBJECTIVE
  To study the cost-effectiveness of vaccination for hepatitis A.
  
  
  METHODS
  Hypothetical analysis of students currently enrolled in medical school in the United States.
  
  
  METHODS
  A Markov-based model was developed using data from the literature, actual hospital costs, and an annual discount rate of 5%. The incidence rate was based on the lowest annual rate for the US population during the past decade.
  
  
  RESULTS
  Over the lifetimes of students currently in medical school, the model estimated that there would be 286 hepatitis A cases with four deaths and 107 lost years of life. With routine vaccination, these numbers would decrease to 17, 0.3, and 6, respectively. The costs per life-year saved and quality adjusted life-year saved were $58,000 and $47,000, respectively. Serologic screening prior to vaccination was less cost-effective than universal vaccination. If the incidence of hepatitis A was underestimated by a factor of 5, the cost per life-year saved would decrease to $5,500. If the incidence of hepatitis was underestimated by a factor of 10, vaccination would result in a net cost savings.
  
  
  CONCLUSIONS
  We conclude that the cost per life-year saved by routine hepatitis A vaccination was similar to many other standard medical modalities. For routine vaccination of medical students to be cost-saving, the incidence rate for hepatitis A must be at least 10 times higher than the rate presently reported for the general population. Serological screening prior to vaccination was not cost-effective.
authors.affiliation: University of Iowa College of Medicine, Iowa City, USA.
authors.forename: S
authors.initials: S
authors.lastname: Smith
authors.forename: S
authors.initials: S
authors.lastname: Weber
authors.forename: T
authors.initials: T
authors.lastname: Wiblin
authors.forename: M
authors.initials: M
authors.lastname: Nettleman
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D003428:Cross Infection / Q000191:economics / Q000401:mortality / Q000517:prevention & control*; D005260:Female; D006506:Hepatitis A / Q000191:economics / Q000401:mortality / Q000517:prevention & control*; D022362:Hepatitis A Vaccines; D006801:Humans; D008297:Male; D008390:Markov Chains; D009784:Occupational Diseases / Q000191:economics / Q000401:mortality / Q000517:prevention & control*; D010564:Personnel, Hospital / Q000191:economics; D011336:Probability; D019057:Quality-Adjusted Life Years; D013337:Students, Medical / Q000706:statistics & numerical data; D014481:United States; D014761:Viral Hepatitis Vaccines / Q000008:administration & dosage / Q000191:economics*
chemical_list: D022362:Hepatitis A Vaccines; D014761:Viral Hepatitis Vaccines