The cost-effectiveness of universal vaccination of children against hepatitis A in Argentina: results of a dynamic health-economic analysis.
BACKGROUND
Socioeconomic improvements can reduce levels of endemic hepatitis A, but conversely increase the burden of disease. Routine childhood vaccination can rapidly control hepatitis A infection rates through the induction of herd immunity, although such programs can be costly.


METHODS
We evaluated the healthcare benefits and cost-effectiveness of a routine childhood vaccination program against hepatitis A in Argentina, using a dynamic model that incorporated the changing epidemiology of infection and the impact of vaccine-induced herd immunity. Demographic, disease, and economic data from Argentina were used where available.


RESULTS
At 95% coverage, the program would reduce the number of hepatitis A infections by 352,405 annually, avoiding 121,587 symptomatic cases and 428 deaths. Substantial healthcare benefits were also observed with vaccination coverage as low as 70%, which would prevent 295,826 infections. Economically, the program would save 23,989,963 US$ annually at 95% coverage, equivalent to 3,429 US$ per life-year gained. The program remained cost-saving in response to variation in factors, including disease-related costs, discount rate, herd immunity level, and rate of decrease of force of infection. The break-even cost per vaccine dose for the society was 25 US$ in the base-case, more than three times the current public cost of 7 US$ per dose.


CONCLUSIONS
Routine childhood vaccination against hepatitis A showed both health benefits and robust economic benefits in this analysis, supporting the recent decision of the Argentine government to implement such a program.
Lopez
Eduardo
E
Hospital Guttierez, Buenos Aires, Argentina.
Debbag
Roberto
R
Coudeville
Laurent
L
Baron-Papillon
Florence
F
Armoni
Judith
J
D001118:Argentina; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D006506:Hepatitis A / Q000517:prevention & control*; D022362:Hepatitis A Vaccines / Q000191:economics*; D006801:Humans; D007223:Infant
D022362:Hepatitis A Vaccines