Cost-effectiveness of hepatitis A-B vaccine versus hepatitis B vaccine for healthcare and public safety workers in the western United States.
OBJECTIVE
To determine the cost-effectiveness of substituting hepatitis A-B vaccine for hepatitis B vaccine when healthcare and public safety workers in the western United States are immunized to protect against occupational exposures to hepatitis B.


METHODS
A cohort of 100,000 hypothetical healthcare and public safety workers from 11 western states with hepatitis A rates twice the national average.


METHODS
A Markov model of hepatitis A was developed using estimates from U.S. government databases, published literature, and an expert panel. Added costs of hepatitis A-B vaccine were compared with savings from reduced hepatitis A treatment and work loss. Cost-effectiveness was expressed as the ratio of net costs to quality-adjusted life-years (QALYs) gained.


RESULTS
Substituting hepatitis A-B vaccine would prevent 29,796 work-loss-days, 222 hospitalizations, 6 premature deaths, and the loss of 214 QALYs. Added vaccination costs of $5.4 million would be more than offset by $1.9 million and $6.1 million reductions in hepatitis A treatment and work loss costs, respectively. Cost-effectiveness improves as the time horizon is extended, from $232,600 per QALY after 1 year to less than $0 per QALY within 11 years. Estimates are most sensitive to community-wide hepatitis A rates and the degree to which childhood vaccination may reduce future rates.


CONCLUSIONS
For healthcare and public safety workers in western states, substituting hepatitis A-B vaccine for hepatitis B vaccine would reduce morbidity, mortality, and costs.
Capitol Outcomes Research, Inc., Alexandria, Virginia 22310, USA.
R Jake
RJ
Jacobs
Gene A
GA
Gibson
Allen S
AS
Meyerhoff
D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D006282:Health Personnel / Q000706:statistics & numerical data*; D022362:Hepatitis A Vaccines / Q000191:economics*; D017325:Hepatitis B Vaccines / Q000191:economics*; D006801:Humans; D008390:Markov Chains; D015233:Models, Statistical; D009784:Occupational Diseases / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D016273:Occupational Exposure / Q000191:economics / Q000517:prevention & control* / Q000706:statistics & numerical data; D011788:Quality of Life; D014481:United States / Q000453:epidemiology; D017778:Vaccines, Combined
D022362:Hepatitis A Vaccines; D017325:Hepatitis B Vaccines; D017778:Vaccines, Combined; C433226:twinrix