Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-02T20:18:57.130Z Has data issue: false hasContentIssue false

Cost-Effectiveness of Hepatitis A Vaccination in Healthcare Workers

Published online by Cambridge University Press:  02 January 2015

Shanon Smith
Affiliation:
University of Iowa College of Medicine, Iowa City, Iowa
Stefan Weber
Affiliation:
Virginia Commonwealth University, and the Deutscher Akademischer Austauschdienst, Germany
Todd Wiblin
Affiliation:
University of Iowa College of Medicine, Iowa City, Iowa
Mary Nettleman*
Affiliation:
Virginia Commonwealth University, Richmond, Virginia
*
Division of General Medicine, Department of Internal Medicine, VCU/Medical College of Virginia, PO Box 980102, Richmond, VA 23298-0102

Abstract

Objective:

To study the cost-effectiveness of vaccination for hepatitis A.

Setting:

Hypothetical analysis of students currently enrolled in medical school in the United States.

Method:

A Markov-based model was developed using data from the literature, actual hospital costs, and an annual discount rate of 5%. The incidence rate was based on the lowest annual rate for the US population during the past decade.

Results:

Over the lifetimes of students currently in medical school, the model estimated that there would be 286 hepatitis A cases with four deaths and 107 lost years of life. With routine vaccination, these numbers would decrease to 17, 0.3, and 6, respectively. The costs per life-year saved and quality adjusted life-year saved were $58,000 and $47,000, respectively. Serologic screening prior to vaccination was less cost-effective than universal vaccination. If the incidence of hepatitis A was underestimated by a factor of 5, the cost per life-year saved would decrease to $5,500. If the incidence of hepatitis was underestimated by a factor of 10, vaccination would result in a net cost savings.

Conclusion:

We conclude that the cost per life-year saved by routine hepatitis A vaccination was similar to many other standard medical modalities. For routine vaccination of medical students to be cost-saving, the incidence rate for hepatitis A must be at least 10 times higher than the rate presently reported for the general population. Serological screening prior to vaccination was not cost-effective.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1997

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Hadler, SC. Global impact of hepatitis A virus infection: changing patterns. In: Hollinger, FB, Lemon, SM, Margolis, HS, eds. Viral Hepatitis and Liver Disease. Baltimore, MD: Williams & Wilkins; 1991:1420.Google Scholar
2. US Department of Health and Human Services. Centers for Disease Control and Prevention, Hepatitis Surveillance. Report No. 55; 06 1994.Google Scholar
3. Shapiro, CN, Coleman, PJ, McQuillan, GM, Alter, MJ, Margolis, HS. Epidemiology of hepatitis A: seroepidemiology and risk groups in the USA. Vaccine 1992;10(suppl 1):S59S61.Google Scholar
4. Eisenstein, AB, Aach, RD, Jacobsohn, W, Goldman, A. An epidemic of infectious hepatitis in a general hospital: probable transmission by contaminated orange juice. JAMA 1993; 185:171174.CrossRefGoogle Scholar
5. Meyers, JD, Romm, FJ, Tihen, WS, Bryan, JA. Food-borne hepatitis A in a general hospital: epidemiologic study of an outbreak attributed to sandwiches. JAMA 1975;231:10491053.Google Scholar
6. Doebbeling, BN, Li, N, Wenzel, RP. An outbreak of hepatitis A among healthcare workers: risk factors for transmission. Am J Public Health 1993;83:16791684.Google Scholar
7. Germanaud, J. Hepatitis A and health care personnel. Arch Intern Med 1994;154:820822.Google Scholar
8. Van Damme, P, Cramm, M, Van der Auwera, J-C., Meheus, A. Hepatitis A vaccination for health care workers. BMJ 1993;306:1615.CrossRefGoogle ScholarPubMed
9. Lemon, SM. Inactivated hepatitis A vaccine. JAMA 1994; 271:13631364.Google Scholar
10. Innis, BL, Snitbhan, R, Kunasol, P, et al. Protection against hepatitis A by an inactivated vaccine. JAMA 1994;271:13281364.CrossRefGoogle ScholarPubMed
11. Werzberger, A, Mensch, B, Kuter, B, et al. A controlled trial of a formalin-inactivated hepatitis A vaccine in healthy children. N Engl J Med 1992;327:453457.Google Scholar
12. An overview of the clinical development of hepatitis A vaccine. In: Hollinger, FB, ed. J Infect Dis 1995;171(suppl 1):177.Google Scholar
13. Victor, J, Knudsen, JD, Nielsen, LP, et al. Hepatitis A vaccine: a new convenient single-dose schedule with booster when long-term immunization is warranted. Vaccine 1994;12:13271329.CrossRefGoogle ScholarPubMed
14. Briem, H, Safary, A. Immunogenicity and safety in adults of hepatitis A virus vaccine administered as a single dose with a booster 6 months later. J Med Virol 1994;44:443445.Google Scholar
15. Van Damme, P, Thoelen, S, Cramm, M, DeGroote, K, Safary, A, Meheus, A. Inactivated hepatitis A vaccine: reactogenicity, immunogenicity, and long-term antibody persistence. J Med Virol 1994;44:446451.Google Scholar
16. Andre, FE, D'Hondt, E, Delem, A, Safary, A. Clinical assessment of the safety and efficacy of an inactivated hepatitis A vaccine: rationale and summary of findings. Vaccine 1992; 10(suppl):S160S168.CrossRefGoogle ScholarPubMed
17. Clemens, R, Safary, A, Hepburn, A, Roche, C, Stanbury, WJ, Andre, FE. Clinical experience with an inactivated hepatitis A vaccine. J Infect Dis 1995;171(suppl 1):S44S49.CrossRefGoogle ScholarPubMed
18. Wiedermann, G, Ambrosch, F, Andre, FE, Hondt, ED, Delem, A, Safary, A. Persistence of vaccine-induced antibody to hepatitis A virus. Vaccine 1992;10(suppl 1):S129S131.Google Scholar
19. Association of American Medical Colleges. Medical School Admission Requirements 1995–6. Washington, DC; 1994:36.Google Scholar
20. Steffen, R, Rickenbach, M, Wilhelm, U, Helminger, A, Schar, M. Health problems after travel to developing countries. J Infect Dis 1987;156:8491.CrossRefGoogle ScholarPubMed
21. Physician Marketplace Statistics. Chicago, IL: Center for Health Policy Research. Chicago, IL: American Medical Association; 1994:24,99.Google Scholar
22. Centers for Disease Control and Prevention. Summary of Notifiable Diseases, United States. MMWR 1994;43(no. 53):69.Google Scholar
23. Tilzey, AJ, Banatvala, JE. Hepatitis A: changing prevalence and possible vaccines. BMJ 1991;302:15521553.Google Scholar
24. Margolis, HS, Alter, MJ. Will Hepatitis A become a vaccine-preventable disease? Ann Intern Med 1995;122:464465.Google Scholar
25. Hawkins, RE, Malone, JD, Coninger, LA, et al. Risk of viral hepatitis among military personnel assigned to US navy ships. J Infect Dis 1992;165:716719.CrossRefGoogle ScholarPubMed
26. Sonnenberg, FA, Beck, JR. Markov models in medical decision making: a practical guide. Med Decis Making 1993;13:322328.CrossRefGoogle ScholarPubMed
27. Beck, JR, Pauker, SG. The Markov process in medical prognosis. Med Decis Making 1983;3:419458.CrossRefGoogle ScholarPubMed
28. Van Doorslaer, E, Tormans, G, Van Damme, P. Cost-effectiveness analysis of vaccination against hepatitis A in travelers. J Med Virol 1994;44:463469.CrossRefGoogle Scholar
29. Wagner, JL, Herdman, RC, Wadhwa, S. Cost-effectiveness of colorectal cancer screening in the elderly. Ann Intern Med 1991;115:807817.Google Scholar
30. Sisk, JE, Riegelman, RK. Cost-effectiveness of vaccination against pneumococcal pneumonia: an update. Ann Intern Med 1986;104:7986.CrossRefGoogle ScholarPubMed
31. Bloom, BS, Hillman, AL, Fendrick, AM, Schwartz, JS. A reappraisal of hepatitis B virus vaccination strategies using cost-effectiveness analysis. Ann Intern Med 1993;118:298306.CrossRefGoogle ScholarPubMed