An economic assessment of pre-vaccination screening for hepatitis A and B.
OBJECTIVE
The availability of a single vaccine active against hepatitis A and B may facilitate prevention of both infections, but complicates the question of whether to conduct pre-vaccination screening. The authors examined the cost-effectiveness of pre-vaccination screening for several populations: first-year college students, military recruits, travelers to hepatitis A-endemic areas, patients at sexually transmitted disease clinics, and prison inmates.


METHODS
Three prevention protocols were examined: (1) screen and defer vaccination until serology results are known; (2) screen and begin vaccination immediately to avoid a missed vaccination opportunity; and (3) vaccinate without screening. Data describing pre-vaccination immunity, vaccine effectiveness, and prevention costs borne by the health system (i.e., serology, vaccine acquisition, and administration) were derived from published literature and U.S. government websites. Using spreadsheet models, the authors calculated the ratio of prevention costs to the number of vaccine protections conferred.


RESULTS
The vaccinate without screening protocol was most cost-effective in nine of 10 analyses conducted under baseline assumptions, and in 69 of 80 sensitivity analyses. In each population considered, vaccinate without screening was less costly than and at least equally as effective as screen and begin vaccination. The screen and defer vaccination protocol would reduce costs in seven populations, but effectiveness would also be lower.


CONCLUSIONS
Unless directed at vaccination candidates with the highest probability of immunity, pre-vaccination screening for hepatitis A and B immunity is not cost-effective. Balancing cost reduction with reduced effectiveness, screen and defer may be preferred for older travelers and prison inmates.
Jacobs
R Jake
RJ
Capitol Outcomes Research, Inc., Alexandria, VA 22310, USA. jake.jacobs@capitoloutcomesresearch.com
Saab
Sammy
S
Meyerhoff
Allen S
AS
Koff
Raymond S
RS
D000293:Adolescent; D000328:Adult; D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D017048:Health Care Costs / Q000145:classification / Q000706:statistics & numerical data*; D006506:Hepatitis A / Q000097:blood* / Q000517:prevention & control; D030041:Hepatitis A virus / Q000302:isolation & purification; D006509:Hepatitis B / Q000097:blood* / Q000517:prevention & control; D006515:Hepatitis B virus / Q000302:isolation & purification; D006801:Humans; D007115:Immunization Schedule; D008403:Mass Screening / Q000191:economics* / Q000592:standards / Q000706:statistics & numerical data*; D008875:Middle Aged; D012698:Serologic Tests; D015229:Sexually Transmitted Diseases, Viral / Q000097:blood; D014195:Travel; D014481:United States; D014611:Vaccination / Q000191:economics* / Q000592:standards / Q000706:statistics & numerical data*; D014761:Viral Hepatitis Vaccines / Q000008:administration & dosage* / Q000191:economics
D014761:Viral Hepatitis Vaccines