title: The cost-effectiveness of hepatitis A vaccination in patients with chronic hepatitis C.
abstract: Infection with hepatitis A virus (HAV) occasionally leads to acute liver failure and has a higher fatality rate in patients with chronic hepatitis C virus (HCV). Vaccination of patients with HCV against HAV is effective and well tolerated. This study examines the cost-effectiveness of HAV vaccination in North American patients with chronic HCV. A decision analysis model was constructed to compare 3 HAV vaccination strategies in adult patients with chronic HCV over a period of 5 years: (1) vaccinate no patients (treat none); (2) vaccinate only susceptible (anti-HAV negative) patients (selective); or (3) vaccinate all patients without prior testing of immune status (universal). Probabilities and direct costs were estimated from hospital data and the literature. The cost per patient for the 3 vaccination strategies were: treat none, $2.00; selective, $56.00; and universal, $82.00. For every 1,000,000 patients with HCV vaccinated over a 5-year period, the selective strategy prevented 128 symptomatic cases of HAV, 3 liver transplantations, and 3 deaths owing directly to HAV compared with the treat none strategy. In addition, the selective strategy costs an additional $427,000 per patient with HAV prevented, and $23 million per HAV-related death averted, compared with the treat none strategy. The results were most sensitive to the incidence of HAV infection; vaccination increased costs if the annual rate of infection was less than 0.56% (baseline, 0.01%). Vaccination of North American patients with chronic HCV against HAV infection is not a cost-effective therapy.
authors.affiliation: Department of Medicine, Division of Gastroenterology, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada.
authors.forename: R P
authors.initials: RP
authors.lastname: Myers
authors.forename: J C
authors.initials: JC
authors.lastname: Gregor
authors.forename: P J
authors.initials: PJ
authors.lastname: Marotta
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D006506:Hepatitis A / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D022362:Hepatitis A Vaccines; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000401:mortality; D006801:Humans; D016031:Liver Transplantation; D014761:Viral Hepatitis Vaccines / Q000191:economics*
chemical_list: D022362:Hepatitis A Vaccines; D014761:Viral Hepatitis Vaccines