title: Cost-effectiveness analysis of universal childhood hepatitis A vaccination in Brazil: regional analyses according to the endemic context.
abstract: OBJECTIVE
  To conduct a cost-effectiveness analysis of a universal childhood hepatitis A vaccination program in Brazil.
  
  
  METHODS
  An age and time-dependent dynamic model was developed to estimate the incidence of hepatitis A for 24 years. The analysis was run separately according to the pattern of regional endemicity, one for South+Southeast (low endemicity) and one for the North+Northeast+Midwest (intermediate endemicity). The decision analysis model compared universal childhood vaccination with current program of vaccinating high risk individuals. Epidemiologic and cost estimates were based on data from a nationwide seroprevalence survey of viral hepatitis, primary data collection, National Health Information Systems and literature. The analysis was conducted from both the health system and societal perspectives. Costs are expressed in 2008 Brazilian currency (Real).
  
  
  RESULTS
  A universal immunization program would have a significant impact on disease epidemiology in all regions, resulting in 64% reduction in the number of cases of icteric hepatitis, 59% reduction in deaths for the disease and a 62% decrease of life years lost, in a national perspective. With a vaccine price of R$16.89 (US$7.23) per dose, vaccination against hepatitis A was a cost-saving strategy in the low and intermediate endemicity regions and in Brazil as a whole from both health system and society perspective. Results were most sensitive to the frequency of icteric hepatitis, ambulatory care and vaccine costs.
  
  
  CONCLUSIONS
  Universal childhood vaccination program against hepatitis A could be a cost-saving strategy in all regions of Brazil. These results are useful for the Brazilian government for vaccine related decisions and for monitoring population impact if the vaccine is included in the National Immunization Program.
authors.affiliation: Clínica de Moléstias Infecciosas do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil. anasartori@gmail.com
authors.forename: Ana Marli C
authors.initials: AM
authors.lastname: Sartori
authors.forename: Patrícia Coelho
authors.initials: PC
authors.lastname: de Soárez
authors.forename: Hillegonda Maria Dutilh
authors.initials: HM
authors.lastname: Novaes
authors.forename: Marcos
authors.initials: M
authors.lastname: Amaku
authors.forename: Raymundo Soares
authors.initials: RS
authors.lastname: de Azevedo
authors.forename: Regina Célia
authors.initials: RC
authors.lastname: Moreira
authors.forename: Leila Maria Moreira Beltrão
authors.initials: LM
authors.lastname: Pereira
authors.forename: Ricardo Arraes de Alencar
authors.initials: RA
authors.lastname: Ximenes
authors.forename: Celina Maria Turchi
authors.initials: CM
authors.lastname: Martelli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D006506:Hepatitis A / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control*; D022362:Hepatitis A Vaccines / Q000008:administration & dosage* / Q000191:economics*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D014611:Vaccination / Q000191:economics* / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D022362:Hepatitis A Vaccines