title: Cost-utility of universal hepatitis A vaccination in Canada.
abstract: Hepatitis A (HA) vaccination in Canada is currently targeted toward high-risk groups. The cost-effectiveness and expected health outcomes of universal vaccination relative to targeted vaccination in low-incidence countries such as Canada are currently unknown. Here, we conducted a cost-utility analysis for this situation, with Canada as the study population. We included vaccine costs, time costs, infection costs, and public health costs. We assessed a range of possible universal vaccination strategies over an 80-year time horizon using multiple cost perspectives. A dynamic model was used to account for herd immunity. Aggregate health gains from switching to universal vaccination are modest (10-30 QALYs per year). However, a "9+9" strategy that replaces two doses of monovalent hepatitis B (HB) vaccine at 9/10 years (universally administered in most provinces) with two doses of bivalent HA/HB vaccine is cost-saving from the societal perspective. At a willingness to pay threshold of $50,000/QALY, mean net benefit is +49.4 QALYs (S.D. 12.6) from the societal perspective and +3.8 QALYS (S.D. 3.0) from the payer perspective for the "9+9" strategy. Net benefit from the payer perspective is sensitive to the marginal cost of HA/HB vaccine relative to HB vaccine. Similar conclusions may apply in other countries with low incidence and a targeted vaccination policy.
authors.affiliation: University of Guelph, Department of Mathematics and Statistics, Guelph, Ontario, Canada. cbauch@uoguelph.ca
authors.forename: C T
authors.initials: CT
authors.lastname: Bauch
authors.forename: A M
authors.initials: AM
authors.lastname: Anonychuk
authors.forename: B Z
authors.initials: BZ
authors.lastname: Pham
authors.forename: V
authors.initials: V
authors.lastname: Gilca
authors.forename: B
authors.initials: B
authors.lastname: Duval
authors.forename: M D
authors.initials: MD
authors.lastname: Krahn
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002170:Canada / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003627:Data Interpretation, Statistical; D005260:Female; D006506:Hepatitis A / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D022362:Hepatitis A Vaccines / Q000191:economics* / Q000276:immunology*; D006801:Humans; D007115:Immunization Schedule; D007223:Infant; D008297:Male; D032541:Mass Vaccination / Q000191:economics*; D008875:Middle Aged; D015233:Models, Statistical; D011153:Population; D019057:Quality-Adjusted Life Years
chemical_list: D022362:Hepatitis A Vaccines