title: Costs and cost-effectiveness of a universal, school-based hepatitis B vaccination program.
abstract: OBJECTIVE
  This study evaluated the costs and cost-effectiveness of a school-based grade 6 universal vaccination program against hepatitis B.
  
  
  METHODS
  We performed a descriptive cost study and cost-effectiveness analysis of British Columbia's vaccination program for 1994 and 1995. Since 1992, public health nurses have administered hepatitis B vaccine to grade 6 students in schools. We measured costs of vaccine, vaccine administration, and net program costs and used a validated Markov model to calculate the cost-effectiveness of the program.
  
  
  RESULTS
  Vaccinating each student cost $44, $24 of which was the cost of vaccine administration. The net cost was $9 per person; considering productivity costs, net savings were $75 per person. Marginal cost per life year gained was $2100. Universal adolescent vaccination is also economically attractive in the United States but less attractive in regions with incidence rates below 3 cases per 100,000 per year.
  
  
  CONCLUSIONS
  Hepatitis B vaccine can be delivered in North American schools at a reasonable cost. Adolescent vaccination is economically attractive in North American regions of high and average incidence rates. Our analysis supports vaccination in adolescents who remain at risk for hepatitis B virus infection.
authors.affiliation: Department of Medicine, University of Toronto, Ontario, Canada. murray.krahn@utoronto.ca
authors.forename: M
authors.initials: M
authors.lastname: Krahn
authors.forename: R
authors.initials: R
authors.lastname: Guasparini
authors.forename: M
authors.initials: M
authors.lastname: Sherman
authors.forename: A S
authors.initials: AS
authors.lastname: Detsky
mesh_terms: D001955:British Columbia; D002648:Child; D003362:Cost-Benefit Analysis; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006302:Health Services Research; D006304:Health Status; D006509:Hepatitis B / Q000191:economics / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D008390:Markov Chains; D015397:Program Evaluation; D011637:Public Health Nursing; D012572:School Health Services / Q000191:economics*; D012680:Sensitivity and Specificity; D014611:Vaccination / Q000191:economics*