The cost-effectiveness of vaccinating chronic hepatitis C patients against hepatitis A.
OBJECTIVE
Although hepatitis A vaccination is recommended for persons with chronic liver disease, the cost-effectiveness of vaccinating patients with chronic hepatitis C virus has not been extensively studied. We evaluated its costs and benefits.


METHODS
A Markov model was used to assess cost-effectiveness from the health system and societal perspectives. Costs of hepatitis A screening and vaccination were compared with savings from reduced hepatitis A treatment and work loss to determine net costs of a "screen and vaccinate" strategy. Net costs were compared with longevity gains to assess cost-effectiveness.


RESULTS
Based on hypothetical cohorts of 100,000 patients, vaccination would reduce the number of hepatitis A cases 63-72%, depending on patient age. Screening and vaccination costs of $5.2 million would be partially offset by $1.5-$2.8 million reductions in hepatitis A treatment costs and $0.2-$1.0 million reductions in work loss costs. From the health system perspective, vaccination would cost $22,256, $50,391, and $102,064 per life-year saved for patients vaccinated at ages 30, 45, and 60 yr, respectively. Cost-effectiveness ratios improve when work loss prevention is considered. Results are most sensitive to hepatitis A infection and hospitalization rates, and the rate used to discount future benefits to their present values.


CONCLUSIONS
Hepatitis A vaccination of chronic hepatitis C patients would substantially reduce morbidity and mortality in all age groups examined. Consistent with other medical interventions for chronic hepatitis C patients, cost-effectiveness is most favorable for younger patients.
Jacobs
R Jake
RJ
Capitol Outcomes Research, Alexandria, Virginia 22310, USA.
Koff
Raymond S
RS
Meyerhoff
Allen S
AS
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs; D006506:Hepatitis A / Q000150:complications / Q000517:prevention & control*; D022362:Hepatitis A Vaccines / Q000008:administration & dosage* / Q000191:economics*; D019698:Hepatitis C, Chronic / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014481:United States; D014611:Vaccination / Q000191:economics*
D022362:Hepatitis A Vaccines