title: Hepatitis B immunization: cost calculation in a community-based study in India.
abstract: OBJECTIVE
  In India, approximately 65% of mothers deliver at home, and a community-based study evaluating the cost of vaccinating newborns with the first dose of hepatitis B vaccine within 48 hours has not been undertaken previously. This policy planning study was done to evaluate the costs of such immunization in India.
  
  
  METHODS
  All mothers delivering in the study area (population 65,000) over a 1-year period were tested for hepatitis B surface antigen (HBsAg; ELISA), and babies of positive mothers were vaccinated starting at birth. The cost of such selective vaccination was calculated. The cost of nursing time required for universal immunization was calculated from the data on nursing time required for vaccination in the selective vaccination program. The national cost of universal immunization without testing was calculated as well as cost-benefit and cost-utility in terms of cost per quality-adjusted life-year (QALY) saved. Sensitivity testing considering economies of scale was also factored in.
  
  
  RESULTS
  1100 mothers delivered during the study period. 252 were primiparous. Nationwide universal vaccination would cost Rs 48,000 per QALY saved, which was double the per capita GNP of the country; discounted at 3% the cost was Rs 260,000.
  
  
  CONCLUSIONS
  Universal immunization vaccination with hepatitis B vaccine is not cost-beneficial in India, since cost of every life-year gained with it will exceed India's per capita GNP.
authors.affiliation: Department of Pediatrics, St. Stephen's Hospital, Tis Hazari, New Delhi 110 054.
authors.forename: Mohit
authors.initials: M
authors.lastname: Sahni
authors.forename: Kapil
authors.initials: K
authors.lastname: Jindal
authors.forename: Nalini
authors.initials: N
authors.lastname: Abraham
authors.forename: Kumudha
authors.initials: K
authors.lastname: Aruldas
authors.forename: Jacob M
authors.initials: JM
authors.lastname: Puliyel
mesh_terms: D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D004467:Economics; D006509:Hepatitis B / Q000191:economics / Q000517:prevention & control*; D006801:Humans; D007194:India; D007231:Infant, Newborn; D019057:Quality-Adjusted Life Years; D014611:Vaccination / Q000191:economics*