title: Cost-effectiveness analysis of hepatitis A vaccination strategies for adults.
abstract: Our objective in this study was to determine the cost-effectiveness of hepatitis A vaccination strategies in healthy adults in the United States. We constructed a decision model simulating costs and health consequences for otherwise healthy adults with respect to hepatitis A prevention. Three strategies were compared: (1) no intervention, (2) vaccination against hepatitis A, and (3) testing for antibodies to hepatitis A and vaccinating those without antibodies. Costs and probabilities were obtained from the published literature. One- and two- way sensitivity analyses were performed. Under baseline conditions, the "test" strategy cost $230,100 per life-year saved compared with the "no intervention" strategy. The incremental cost-effectiveness of the "vaccination" strategy compared with the "test" strategy was $20.1 million per life-year saved. The "test" strategy was cost-effective when the hepatitis A case fatality rate exceeded 17% (baseline 2.7%). The "vaccination" strategy was cost-effective when 1 dose of vaccine cost $7 or less (baseline $57). Under baseline conditions, neither the "test" nor the "vaccination" strategies are considered cost-effective according to current standards. Large changes in hepatitis A incidence, mortality rates, or vaccine cost are required for either of the intervention strategies to approach potentially cost-effectiveness. Such conditions may occur in areas in which hepatitis A is endemic, and/or under mass-vaccination scenarios.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC, USA. oconn003@mc.duke.edu
authors.forename: J B
authors.initials: JB
authors.lastname: O'Connor
authors.forename: T F
authors.initials: TF
authors.lastname: Imperiale
authors.forename: M E
authors.initials: ME
authors.lastname: Singer
mesh_terms: D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D006506:Hepatitis A / Q000517:prevention & control*; D006508:Hepatitis Antibodies / Q000032:analysis; D006507:Hepatovirus / Q000276:immunology; D006801:Humans; D008875:Middle Aged; D012680:Sensitivity and Specificity; D014481:United States; D014611:Vaccination / Q000191:economics*; D014761:Viral Hepatitis Vaccines / Q000191:economics* / Q000627:therapeutic use*
chemical_list: D006508:Hepatitis Antibodies; D014761:Viral Hepatitis Vaccines