Cost-effectiveness of hepatitis B vaccination in haemodialysis patients.
BACKGROUND
Vaccination against hepatitis B virus is an important means of controlling the infection, but its role in haemodialysis patients has been questioned due to the latter's impaired immune response.


METHODS
Forty-eight of 79 haemodialysis patients who were negative for antibodies to both hepatitis B surface and core antigens were entered into a vaccination programme. Standard doses of a plasma-derived vaccine were administered into the deltoid muscle at 0, 1, 2 and 4 months, and the antibody response was measured at 1 and 2 months after the third and fourth doses.


RESULTS
The peak mean antibody titre of 372 IU/l was recorded at 1 month after the fourth dose, and the maximum response rate was achieved at 2 months after the final dose. Seroconversion occurred in 26 of 36 patients (72%) who completed the programme, and protective levels of antibody above 10 IU/l were found in 25 of 36 patients (69%). Cost analysis of the project revealed a net saving of +/- R90/patient entered at the end of the first year, due to the reduced number of patients requiring monthly surveillance tests for hepatitis B surface antigen. After that, an annual saving of +/- R380/patient is projected.


CONCLUSIONS
In view of the high prevalence of chronic hepatitis B carriers in the South African population, the reduction in the number of patients at risk of infection, combined with a net cost saving, makes it reasonable to recommend vaccination in all non-immune haemodialysis patients despite a reduced response rate.
Taal
M W
MW
Renal Unit, Department of Medicine, Groote Schuur Hospital, Cape Town.
van Zyl-Smit
R
R
D000328:Adult; D003362:Cost-Benefit Analysis; D005260:Female; D006509:Hepatitis B / Q000191:economics* / Q000517:prevention & control; D017325:Hepatitis B Vaccines / Q000008:administration & dosage / Q000191:economics*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000191:economics*; D013019:South Africa
D017325:Hepatitis B Vaccines