Pharmaco-economic evaluation of targeted hepatitis A vaccination for children of ethnic minorities in Amsterdam (The Netherlands).
OBJECTIVE
Estimate cost-effectiveness of vaccination against hepatitis A virus (HAV) for children of ethnic minorities in Amsterdam.


BACKGROUND
Pharmaco-economic analysis is relevant for motivating reimbursement of vaccination costs in the framework of a programmatic approach to vaccination of ethnic minorities.


METHODS
Pharmaco-economic modeling.


METHODS
In cost-effectiveness analysis, costs, benefits and health gains were estimated for a large-scale HAV-vaccination for children of Turkish and Maroccan origin. Analysis was performed from the societal perspective, as recommended in the Dutch guidelines for pharmaco-economic research. This implies that indirect costs of production losses are included in the analysis. Cost-effectiveness was expressed in net costs per adult HAV-infection averted in incremental and aggregate analysis. Incremental analysis compares targeted vaccination with the current limited-scale HAV-vaccination that exists, whereas aggregate analysis compares targeted vaccination with the sheer absence of vaccination.


RESULTS
Net aggregate costs of targeted HAV-vaccination for Turkish and Maroccan children in Amsterdam amounts to 61.000. Cost-effectiveness was estimated, in aggregate and incremental analysis, at 13.500 and 11.100 respectively per adult HAV-infection averted. Uni- and multivariate sensitivity analyses show that major impact on cost-effectiveness may be expected from reductions in the vaccine price through economies of scale. Probabilistic sensitivity analysis indicates possible large fluctuations in cost-effectiveness from 1 year to another, related to varying incidence of disease.


CONCLUSIONS
HAV-vaccination for children from ethnic minorities in Amsterdam is not cost saving, but may have a favourable cost-effectiveness. Such a vaccination program fits into the recent Dutch policy of specific vaccinations directed at groups of ethnic minorities, such as for hepatitis B.
Postma
M J
MJ
Groningen University Institute for Drug Exploration/University of Groningen Research Institute of Pharmacy (GUIDE/GRIP), Groningen, The Netherlands.
Bos
J M
JM
Beutels
Ph
P
Schilthuis
H
H
van den Hoek
J A R
JA
D000328:Adult; D002648:Child; D003362:Cost-Benefit Analysis; D004196:Disease Outbreaks / Q000191:economics; D006506:Hepatitis A / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D022362:Hepatitis A Vaccines / Q000191:economics*; D006801:Humans; D007349:Insurance, Health, Reimbursement; D008913:Minority Groups; D009426:Netherlands / Q000453:epidemiology; D014611:Vaccination / Q000191:economics*
D022362:Hepatitis A Vaccines