The cost-effectiveness of hepatitis A vaccination in patients with chronic hepatitis C viral infection in the United States.
OBJECTIVE
Hepatitis A vaccination is recommended for patients with chronic hepatitis C. Our aim was to analyze the cost-effectiveness of hepatitis A vaccination in these patients. The specific strategies evaluated were: no vaccination, targeted vaccination, and universal vaccination.


METHODS
Clinical estimates were based on published data. Costs estimates were based on published data and institutional Medicare reimbursement rates. Health-related quality-of-life weights were derived from published data and expert estimates. The target population consisted of patients 45 yr of age with chronic hepatitis C followed every 6 months until death. We adopted a societal perspective.


RESULTS
Compared with no vaccination, targeted vaccination was associated with an incremental cost-effectiveness ratio of $51,000 per quality-adjusted life-year. The incremental cost-effectiveness ratio of universal vaccination compared with targeted vaccination was $3,900,000 per quality-adjusted life-year. The results were particularly sensitive to the incidence of hepatitis A, probability of fulminant hepatic failure, and costs of hepatitis A antibody screening and vaccination.


CONCLUSIONS
Targeted vaccination for hepatitis A in patients with chronic hepatitis C may be a cost-effective strategy to decrease the morbidity and mortality associated with hepatitis A superinfection. Universal vaccination is not a cost-effective alternative to targeted vaccination in this target population.
Arguedas
Miguel R
MR
Division of Gastroenterology and Hepatology, School of Public Health, University of Alabama at Birmingham, 35294-0007, USA.
Heudebert
Gustavo R
GR
Fallon
Michael B
MB
Stinnett
Aaron A
AA
D000368:Aged; D003362:Cost-Benefit Analysis / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006301:Health Services Needs and Demand / Q000191:economics; D006304:Health Status; D006506:Hepatitis A / Q000191:economics* / Q000401:mortality / Q000517:prevention & control; D022362:Hepatitis A Vaccines / Q000191:economics* / Q000627:therapeutic use; D019698:Hepatitis C, Chronic / Q000191:economics* / Q000401:mortality; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D011788:Quality of Life; D014481:United States; D014611:Vaccination / Q000191:economics*
D022362:Hepatitis A Vaccines