Clinical and economic impact of a combination Haemophilus influenzae and Hepatitis B vaccine: estimating cost-effectiveness using decision analysis.
BACKGROUND
Compliance with hepatitis B virus (HBV) vaccine remains suboptimal, despite a recommendation by the Advisory Committee on Immunization Practices of the US Public Health Service that all newborns be vaccinated. Although a combined HBV-Haemophilus influenzae type b (Hib) vaccine may improve acceptance of the HBV vaccine, the clinical and economic consequences of this intervention are uncertain.


OBJECTIVE
To compare the health impact and cost-effectiveness of the following 2 immunization strategies: current practice of administering HBV vaccine separately (75% compliance) and Hib vaccine alone or as part of a multivalent vaccine (95% compliance); and strategy of delivering a combined HBV-Hib vaccine (95% compliance).


METHODS
A Markov model simulated the natural history of acute and chronic HBV and Hib disease in a cohort of US newborns. Clinical and economic variables were obtained from published reports.


RESULTS
The Hib-related outcomes were the same in both strategies, because the efficacy and compliance with Hib vaccine were assumed to be equivalent in both. A 53% reduction in the number of cases of HBV infection with the combination strategy (n = 8541) was estimated when compared with current practice (n = 18 044), along with 205 fewer HBV-related deaths per 1 million infants. Immunization costs of the combination strategy were $11.5 million higher than for current practice ($108.4 million compared with $96.9 million), whereas the cost of HBV-related disease was $4.0 million lower than in current practice. The incremental cost-effectiveness ratio for the combination strategy was $17700 per year of life saved.


CONCLUSIONS
An HBV-Hib vaccine in US infants yields substantial benefits, with a cost-effectiveness ratio that is lower than that of many commonly used medical interventions.
Fendrick
A M
AM
Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, USA. amfen@umich.edu
Lee
J H
JH
LaBarge
C
C
Glick
H A
HA
D000293:Adolescent; D002648:Child; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D018073:Haemophilus Vaccines / Q000009:adverse effects / Q000191:economics* / Q000276:immunology; D006509:Hepatitis B / Q000191:economics / Q000276:immunology / Q000517:prevention & control*; D017325:Hepatitis B Vaccines / Q000009:adverse effects / Q000191:economics* / Q000276:immunology; D006801:Humans; D017589:Immunization Programs / Q000191:economics; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008390:Markov Chains; D008583:Meningitis, Haemophilus / Q000191:economics / Q000276:immunology / Q000517:prevention & control*; D010043:Outcome and Process Assessment, Health Care; D014481:United States