Cost-effectiveness of hepatitis A-B vaccine versus hepatitis B vaccine for healthcare and public safety workers in the western United States

• Published in: Infection control and hospital epidemiology Vol. 25; no. 7; p. 563
• Main Authors: Jacobs, R Jake, Gibson, Gene A, Meyerhoff, Allen S
• Format: Journal Article
• Language: English
• Published: United States 01.07.2004
• Subjects: Cohort Studies; Cost-Benefit Analysis; Health Personnel - statistics & numerical data; Hepatitis A Vaccines - economics; Hepatitis B Vaccines - economics; Humans; Markov Chains; Models, Statistical; Occupational Diseases - economics; Occupational Diseases - epidemiology; Occupational Diseases - prevention & control; Occupational Exposure - economics; Occupational Exposure - prevention & control; Occupational Exposure - statistics & numerical data; Quality of Life; United States - epidemiology; Vaccines, Combined; United States
• ISSN: 0899-823X
• DOI: 10.1086/502440

To determine the cost-effectiveness of substituting hepatitis A-B vaccine for hepatitis B vaccine when healthcare and public safety workers in the western United States are immunized to protect against occupational exposures to hepatitis B. A cohort of 100,000 hypothetical healthcare and public safety workers from 11 western states with hepatitis A rates twice the national average. A Markov model of hepatitis A was developed using estimates from U.S. government databases, published literature, and an expert panel. Added costs of hepatitis A-B vaccine were compared with savings from reduced hepatitis A treatment and work loss. Cost-effectiveness was expressed as the ratio of net costs to quality-adjusted life-years (QALYs) gained. Substituting hepatitis A-B vaccine would prevent 29,796 work-loss-days, 222 hospitalizations, 6 premature deaths, and the loss of 214 QALYs. Added vaccination costs of $5.4 million would be more than offset by $1.9 million and $6.1 million reductions in hepatitis A treatment and work loss costs, respectively. Cost-effectiveness improves as the time horizon is extended, from $232,600 per QALY after 1 year to less than $0 per QALY within 11 years. Estimates are most sensitive to community-wide hepatitis A rates and the degree to which childhood vaccination may reduce future rates. For healthcare and public safety workers in western states, substituting hepatitis A-B vaccine for hepatitis B vaccine would reduce morbidity, mortality, and costs.