title: Cost-utility analysis of hepatitis A prevention among health-care workers in Israel.
abstract: This study was conducted to evaluate the efficiency of different strategies of preventing hepatitis A (HA) among physicians, nurses, and paramedical staff by means of cost-effectiveness analysis. The strategies compared were passive immunization during a hepatitis A outbreak, systematic mass vaccination of all workers, and screening for antibodies to HA virus followed by vaccination of nonimmune employees. To predict the prevented number of HA cases, an epidemiological model was incorporated based on our previous nationwide study on clinical HA cases, seroepidemiological survey, and other scientific medical literature. Under the model assumptions, the lowest cost per prevented HA case ($6240) was achieved by screening prior vaccination among 18- to 39-year-old physicians and paramedical workers, and highest ($61,858) by mass vaccination of nurses over age 39 years. Because the price per prevented case may show that mass vaccination is highly cost-effective, especially among 18- to 39-year-old physicians and paramedical workers ($6399 and $8196, respectively), the cost per gained quality-adjusted life-year seems less attractive ($56,532 and $61,350, respectively). This cost per saved quality-adjusted life-year is similar to many other medical interventions but is markedly higher than other primary prevention vaccines, which are mostly associated with a negative ratio. In view of the conducted study, and taking $60,000 as a limit cost per saved quality-adjusted life-year, we propose selective vaccination for physicians and for paramedical workers. Mass vaccination should be offered to all health care workers, aside from nurses 40+ years of age, once the active HA vaccine price is reduced to $23.
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Department of Epidemiology & Preventive Medicine, POB 39040 Ramat-Aviv, Tel Aviv 69978, Israel. gabbychodick@hotmail.com
authors.forename: Gabriel
authors.initials: G
authors.lastname: Chodick
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Lerman
authors.forename: Francis
authors.initials: F
authors.lastname: Wood
authors.forename: Hava
authors.initials: H
authors.lastname: Aloni
authors.forename: Tamar
authors.initials: T
authors.lastname: Peled
authors.forename: Shai
authors.initials: S
authors.lastname: Ashkenazi
mesh_terms: D000293:Adolescent; D000328:Adult; D003362:Cost-Benefit Analysis; D005260:Female; D006282:Health Personnel; D006506:Hepatitis A / Q000191:economics* / Q000517:prevention & control*; D022362:Hepatitis A Vaccines / Q000008:administration & dosage / Q000191:economics*; D006801:Humans; D007557:Israel; D008297:Male; D008403:Mass Screening / Q000191:economics; D008875:Middle Aged; D017059:Models, Econometric; D016273:Occupational Exposure; D016272:Occupational Health; D019057:Quality-Adjusted Life Years; D014611:Vaccination / Q000191:economics
chemical_list: D022362:Hepatitis A Vaccines