Cost-effectiveness analysis of catch-up hepatitis A vaccination among unvaccinated/partially-vaccinated children.
Since 2006, the US Centers for Disease Control and Prevention has recommended hepatitis A (HepA) vaccination routinely for children aged 12-23months to prevent hepatitis A virus (HAV) infection. However, a substantial proportion of US children are unvaccinated and susceptible to infection. We present results of economic modeling to assess whether a one-time catch-up HepA vaccination recommendation would be cost-effective.



We developed a Markov model of HAV infection that followed a single cohort from birth through death (birth to age 95years). The model compared the health and economic outcomes from catch-up vaccination interventions for children at target ages from two through 17years vs. outcomes resulting from maintaining the current recommendation of routine vaccination at age one year with no catch-up intervention.



Over the lifetime of the cohort, catch-up vaccination would reduce the total number of infections relative to the baseline by 741 while increasing doses of vaccine by 556,989. Catch-up vaccination would increase net costs by $10.2million, or $2.38 per person. The incremental cost of HepA vaccine catch-up intervention at age 10years, the midpoint of the ages modeled, was $452,239 per QALY gained. Across age-cohorts, the cost-effectiveness of catch-up vaccination is most favorable at age 12years, resulting in an Incremental Cost-Effectiveness Ratio of $189,000 per QALY gained.



Given the low baseline of HAV disease incidence achieved by current vaccination recommendations, our economic model suggests that a catch-up vaccination recommendation would be less cost-effective than many other vaccine interventions, and that HepA catch-up vaccination would become cost effective at a threshold of $50,000 per QALY only when incidence of HAV rises about 5.0 cases per 100,000 population.
Emory University School of Medicine, United States. Electronic address: ahankin@emory.edu.
Abigail
A
Hankin-Wei
NORC, University of Chicago, United States.
David B
DB
Rein
Rollins School of Public Health, Emory University, United States.
Alfonso
A
Hernandez-Romieu
NORC, University of Chicago, United States.
Mallory J
MJ
Kennedy
Arctic Investigations Program, NCEZID, U.S. Centers for Disease Control and Prevention, United States.
Lisa
L
Bulkow
Rollins School of Public Health, Emory University, United States.
Eli
E
Rosenberg
Rollins School of Public Health, Emory University, United States.
Monica
M
Trigg
Division of Viral Hepatitis, NCHHSTP, U.S. Centers for Disease Control and Prevention, United States.
Noele P
NP
Nelson
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D006506:Hepatitis A / Q000517:prevention & control*; D022362:Hepatitis A Vaccines / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D007117:Immunization, Secondary / Q000191:economics*; D018803:Models, Economic; D019057:Quality-Adjusted Life Years; D014611:Vaccination / Q000191:economics*
D022362:Hepatitis A Vaccines
Economic modeling; Hepatitis A; Vaccine recommendation