title: Comparison of the cost and effectiveness of two strategies for maintaining hepatitis B immunity in hemodialysis patients.
abstract: A decision-analysis model was developed to compare the strategies to maintain hepatitis B virus (HBV) immunity in hemodialysis patients who responded to the primary HBV vaccine. Our hypothesis is that the routine, annual administration of the vaccine booster to all hemodialysis patients (non-screening strategy) is more cost-effective than the current strategy of vaccination based on anti-HBs titers (screening strategy). Under baseline assumptions, the screening strategy was less costly and was associated with fewer HBV infections than the non-screening strategy. The results of our model did not support our hypothesis, and indicate that regularly screening patients for HBV immunity before revaccination is less costly and more effective than the empiric vaccination of hemodialysis patients.
authors.affiliation: Department of Medicine, Los Angeles School of Medicine, University of California, Los Angeles, CA 90095, USA. ssaab@mednet.ucla.edu
authors.forename: Sammy
authors.initials: S
authors.lastname: Saab
authors.forename: Shiobhan R
authors.initials: SR
authors.lastname: Weston
authors.forename: David
authors.initials: D
authors.lastname: Ly
authors.forename: Maria
authors.initials: M
authors.lastname: Brezina
authors.forename: Hal F
authors.initials: HF
authors.lastname: Yee
authors.forename: Steven-Huy B
authors.initials: SH
authors.lastname: Han
authors.forename: Gary
authors.initials: G
authors.lastname: Gitnick
mesh_terms: D000465:Algorithms; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003661:Decision Support Techniques; D006509:Hepatitis B / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D006510:Hepatitis B Antibodies / Q000097:blood*; D017325:Hepatitis B Vaccines / Q000008:administration & dosage / Q000191:economics / Q000276:immunology*; D019694:Hepatitis B, Chronic / Q000191:economics / Q000517:prevention & control; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007115:Immunization Schedule; D007117:Immunization, Secondary / Q000191:economics*; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D017093:Liver Failure / Q000191:economics / Q000209:etiology / Q000517:prevention & control; D008403:Mass Screening / Q000191:economics*; D018448:Models, Immunological; D008962:Models, Theoretical; D006435:Renal Dialysis / Q000009:adverse effects; D016036:Seroepidemiologic Studies; D014481:United States
chemical_list: D006510:Hepatitis B Antibodies; D017325:Hepatitis B Vaccines