Cost effectiveness of hepatitis B vaccination strategies in Ireland: an economic evaluation.
BACKGROUND
In accordance with World Health Organization recommendations, many European countries have introduced universal hepatitis B vaccination policies. The UK and Ireland are exceptions. In this study, we conducted an economic evaluation of a universal infant hepatitis B vaccination programme, using a six-component vaccine, compared with the current selective strategy of vaccinating high-risk infants with a monovalent hepatitis B vaccine.


METHODS
A cost effectiveness analysis was conducted using a Markov model. The perspective of the analysis was the Irish Health Service Executive. Unit cost and resource utilization data were derived from expert clinical opinion, published sources, diagnosis-related group costs for hospital admissions and local cost estimates for medical fees and laboratory investigations. A full probabilistic sensitivity analysis was undertaken. Both costs and outcomes were modelled over a period of 80 years and discounted at 3.5%.


RESULTS
Assuming an incidence of acute hepatitis B virus (HBV) infection in Ireland of 8.4 per 100,000 population, the incremental cost effectiveness ratio ranged from euro10,992/life years gained (LYG) to euro67 200/LYG, at the lowest and highest price estimates for the six-component vaccine, respectively. The cost effectiveness of universal versus selective hepatitis B vaccination was sensitive to the risk of acute HBV infection, the cost of the universal infant vaccination programme and the discount rate.


CONCLUSIONS
At a cost of euro29.00 per dose of the six-component vaccine, universal infant hepatitis B vaccination is cost effective at euro37 018/LYG. This compares favourably with other preventive programmes in Ireland.
Tilson
Lesley
L
National Centre for Pharmacoeconomics, St James's University Teaching Hospital, James's St, Dublin 8, Ireland. ltilson@stjames.ie
Thornton
Lelia
L
O'Flanagan
Darina
D
Johnson
Howard
H
Barry
Michael
M
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002648:Child; D002662:Child Health Services; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D006509:Hepatitis B / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control; D017325:Hepatitis B Vaccines / Q000008:administration & dosage / Q000191:economics*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007494:Ireland / Q000453:epidemiology; D008390:Markov Chains; D032541:Mass Vaccination / Q000191:economics*; D008875:Middle Aged; D017059:Models, Econometric; D019057:Quality-Adjusted Life Years
D017325:Hepatitis B Vaccines