Cost effectiveness of hepatitis B vaccination at HIV counseling and testing sites.
BACKGROUND
Despite recent significant achievements in controlling hepatitis B virus (HBV) infection, immunizing high-risk groups against the disease remains a public health challenge in the United States. The aims of this article are to evaluate the projected cost effectiveness of hepatitis B vaccination of adults attending two major types of publicly funded HIV counseling and testing sites (CTSs)-freestanding HIV CTSs and sexually transmitted disease (STD) clinics, and to compare the cost-effectiveness of alternative vaccination and testing strategies in different subgroups in this population.


METHODS
A decision model was developed to determine the economic and clinical consequences, from a societal perspective, of the following strategies in two hypothetical cohorts of 100,000 adults attending each type of site: (1) routine vaccination without screening, (2) screening for antibody to hepatitis B core antigen with an initial vaccine dose during the first visit, (3) screening and vaccination based on screening results, and (4) no intervention. Life expectancy, expected quality-adjusted life years (QALYs), and medical care costs were estimated for each strategy and at each site.


RESULTS
Routine vaccination was both more effective and more cost-effective than either screening strategy; under base-case assumptions, routine vaccination would cost $4400 both per QALY and per life year saved. Results for STD clinics were very similar in magnitude to those for freestanding CTSs. Results were most sensitive to clients' time and travel costs for return visits and the time-discount rate.


CONCLUSIONS
Routine provision of hepatitis B vaccine at major HIV CTSs would be a highly effective and cost-effective approach to preventing hepatitis B among high-risk adults in the United States.
Kim
Sun-Young
SY
Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts 02115, USA. sykim@fas.harvard.edu
Billah
Kaafee
K
Lieu
Tracy A
TA
Weinstein
Milton C
MC
D000328:Adult; D000554:Ambulatory Care Facilities; D003362:Cost-Benefit Analysis; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000175:diagnosis; D006509:Hepatitis B / Q000453:epidemiology / Q000517:prevention & control*; D017325:Hepatitis B Vaccines; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014611:Vaccination / Q000191:economics*
D017325:Hepatitis B Vaccines