Economic analysis of the single-dose immunization strategy against hepatitis A in Argentina.
BACKGROUND
Vaccination against hepatitis A (HA) was carried out only as part of a limited outbreak control strategy in Argentina until June 2005, when universal immunization in infants was introduced into the national immunization calendar. A single-dose strategy was chosen instead of the standard two-dose schedule used elsewhere. This study aimed to estimate preventive, medical, and non-medical costs related to HA and to compare these costs in the periods before and after mass vaccination.


METHODS
A retrospective analysis estimated treatment costs of HA and unspecified hepatitis cases reported to the National Health Surveillance System from 2000 to 2010. Costs related to immunization, fulminant hepatitis (FH), liver transplantation, and death were projected as well. Using a social perspective and a healthcare system perspective, costs in two 5-year periods were compared: 2000-2004 versus 2006-2010. Finally, we evaluated the impact of different discount rates, FH risk, and exclusion of unspecified hepatitis cases in the sensitivity analysis.


RESULTS
Total HA and unspecified hepatitis cases decreased from 157,871 in 2000-2004 to 17,784 in 2006-2010. Medical and non-medical costs decreased from US$11,811,600 and US$30,118,222 to US$1,252,694 and US$4,995,895 in those periods, respectively. Immunization costs increased from US$6,506,711 to US$40,912,132. Total preventive, medical, and non-medical costs decreased from US$48,436,534 to US$47,160,721, representing a 2.6% reduction in total costs between the two periods. When a healthcare system perspective was considered or unspecified hepatitis cases were excluded, total costs were 130.2% and 30.8% higher in 2006-2010 than in the previous period, respectively.


CONCLUSIONS
After implementation of the universal single-dose vaccination against HA in infants in Argentina, an impressive decline was observed in HA cases, with a decrease in medical and non-medical costs in the first 5 years. The single-dose strategy, which is simpler and less expensive than the standard two-dose scheme, can be a good alternative for future vaccination policies in other countries where HA is endemic.
Ministerio de Salud de la Nación, Av. 9 de Julio 1925, C1073ABA Ciudad Autónoma de Buenos Aires, Argentina.
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Vizzotti
Ministerio de Salud de la Nación, Av. 9 de Julio 1925, C1073ABA Ciudad Autónoma de Buenos Aires, Argentina.
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Pippo
Ministerio de Salud de la Nación, Av. 9 de Julio 1925, C1073ABA Ciudad Autónoma de Buenos Aires, Argentina. Electronic address: anauru@yahoo.com.
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Urueña
Ministerio de Salud de la Nación, Av. 9 de Julio 1925, C1073ABA Ciudad Autónoma de Buenos Aires, Argentina.
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Altuna
Ministerio de Salud de la Nación, Av. 9 de Julio 1925, C1073ABA Ciudad Autónoma de Buenos Aires, Argentina.
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Palópoli
Ministerio de Salud de la Nación, Av. 9 de Julio 1925, C1073ABA Ciudad Autónoma de Buenos Aires, Argentina.
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Hernández
Ministerio de Salud de la Nación, Av. 9 de Julio 1925, C1073ABA Ciudad Autónoma de Buenos Aires, Argentina.
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Artola
Ministerio de Salud de la Nación, Av. 9 de Julio 1925, C1073ABA Ciudad Autónoma de Buenos Aires, Argentina.
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Fernández
Ministerio de Salud de la Nación, Av. 9 de Julio 1925, C1073ABA Ciudad Autónoma de Buenos Aires, Argentina.
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Orellano
Hospital de Niños de San Justo, Granada 4175, San Justo 1754, Provincia de Buenos Aires, Argentina.
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Cañero-Velasco
Hospital Alemán, Pueyrredón 1640, 1414 Ciudad Autónoma de Buenos Aires, Argentina.
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Ciocca
Hospital Nacional "Profesor Alejandro Posadas", Pte. Illia s/n y Marconi, El Palomar 1684, Provincia de Buenos Aires, Argentina.
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Ramonet
Ministerio de Salud de la Nación, Av. 9 de Julio 1925, C1073ABA Ciudad Autónoma de Buenos Aires, Argentina.
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Diosque
D001118:Argentina / Q000453:epidemiology; D006291:Health Policy; D006506:Hepatitis A / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D022362:Hepatitis A Vaccines / Q000008:administration & dosage / Q000191:economics* / Q000276:immunology*; D006801:Humans; D017589:Immunization Programs; D015233:Models, Statistical; D012189:Retrospective Studies; D014611:Vaccination / Q000191:economics* / Q000379:methods
D022362:Hepatitis A Vaccines
Argentina; Economic analysis; Hepatitis A; Single-dose vaccination