title: Public Health Impact and Cost-Effectiveness of Hepatitis A Vaccination in the United States: A Disease Transmission Dynamic Modeling Approach.
abstract: OBJECTIVE
  To assess the population-level impact and cost-effectiveness of hepatitis A vaccination programs in the United States.
  
  
  METHODS
  We developed an age-structured population model of hepatitis A transmission dynamics to evaluate two policies of administering a two-dose hepatitis A vaccine to children aged 12 to 18 months: 1) universal routine vaccination as recommended by the Advisory Committee on Immunization Practices in 2006 and 2) Advisory Committee on Immunization Practices's previous regional policy of routine vaccination of children living in states with high hepatitis A incidence. Inputs were obtained from the published literature, public sources, and clinical trial data. The model was fitted to hepatitis A seroprevalence (National Health and Nutrition Examination Survey II and III) and reported incidence from the National Notifiable Diseases Surveillance System (1980-1995). We used a societal perspective and projected costs (in 2013 US $), quality-adjusted life-years, incremental cost-effectiveness ratio, and other outcomes over the period 2006 to 2106.
  
  
  RESULTS
  On average, universal routine hepatitis A vaccination prevented 259,776 additional infections, 167,094 outpatient visits, 4781 hospitalizations, and 228 deaths annually. Compared with the regional vaccination policy, universal routine hepatitis A vaccination was cost saving. In scenario analysis, universal vaccination prevented 94,957 infections, 46,179 outpatient visits, 1286 hospitalizations, and 15 deaths annually and had an incremental cost-effectiveness ratio of $21,223/quality-adjusted life-year when herd protection was ignored.
  
  
  CONCLUSIONS
  Our model predicted that universal childhood hepatitis A vaccination led to significant reductions in hepatitis A mortality and morbidity. Consequently, universal vaccination was cost saving compared with a regional vaccination policy. Herd protection effects of hepatitis A vaccination programs had a significant impact on hepatitis A mortality, morbidity, and cost-effectiveness ratios.
authors.affiliation: Merck & Co., Inc., Kenilworth, NJ, USA; Complete HEOR Solutions, North Wales, PA, USA.
authors.forename: Praveen
authors.initials: P
authors.lastname: Dhankhar
authors.affiliation: Merck & Co., Inc., Kenilworth, NJ, USA.
authors.forename: Chizoba
authors.initials: C
authors.lastname: Nwankwo
authors.affiliation: Merck & Co., Inc., Kenilworth, NJ, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Pillsbury
authors.affiliation: Merck & Co., Inc., Kenilworth, NJ, USA; Lauschke Consulting, Morris Plains, NJ, USA.
authors.forename: Andreas
authors.initials: A
authors.lastname: Lauschke
authors.affiliation: Merck & Co., Inc., Kenilworth, NJ, USA.
authors.forename: Michelle G
authors.initials: MG
authors.lastname: Goveia
authors.affiliation: Merck & Co., Inc., Kenilworth, NJ, USA.
authors.forename: Camilo J
authors.initials: CJ
authors.lastname: Acosta
authors.affiliation: Merck & Co., Inc., Kenilworth, NJ, USA. Electronic address: elamin_elbasha@merck.com.
authors.forename: Elamin H
authors.initials: EH
authors.lastname: Elbasha
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis / Q000379:methods*; D005260:Female; D006506:Hepatitis A / Q000191:economics* / Q000517:prevention & control* / Q000635:transmission; D022362:Hepatitis A Vaccines / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D011634:Public Health / Q000191:economics* / Q000379:methods; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D022362:Hepatitis A Vaccines
keywords: cost-effectiveness analysis; hepatitis A vaccine; hepatitis A virus; herd protection/immunity; simulation