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. 1998 Nov;88(11):1638–1644. doi: 10.2105/ajph.88.11.1638

Costs and cost-effectiveness of a universal, school-based hepatitis B vaccination program.

M Krahn 1, R Guasparini 1, M Sherman 1, A S Detsky 1
PMCID: PMC1508554  PMID: 9807529

Abstract

OBJECTIVES: This study evaluated the costs and cost-effectiveness of a school-based grade 6 universal vaccination program against hepatitis B. METHODS: We performed a descriptive cost study and cost-effectiveness analysis of British Columbia's vaccination program for 1994 and 1995. Since 1992, public health nurses have administered hepatitis B vaccine to grade 6 students in schools. We measured costs of vaccine, vaccine administration, and net program costs and used a validated Markov model to calculate the cost-effectiveness of the program. RESULTS: Vaccinating each student cost $44, $24 of which was the cost of vaccine administration. The net cost was $9 per person; considering productivity costs, net savings were $75 per person. Marginal cost per life year gained was $2100. Universal adolescent vaccination is also economically attractive in the United States but less attractive in regions with incidence rates below 3 cases per 100,000 per year. CONCLUSIONS: Hepatitis B vaccine can be delivered in North American schools at a reasonable cost. Adolescent vaccination is economically attractive in North American regions of high and average incidence rates. Our analysis supports vaccination in adolescents who remain at risk for hepatitis B virus infection.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alter M. J., Mast E. E. The epidemiology of viral hepatitis in the United States. Gastroenterol Clin North Am. 1994 Sep;23(3):437–455. [PubMed] [Google Scholar]
  2. Arevalo J. A., Washington A. E. Cost-effectiveness of prenatal screening and immunization for hepatitis B virus. JAMA. 1988 Jan 15;259(3):365–369. [PubMed] [Google Scholar]
  3. Beasley R. P. Hepatitis B virus. The major etiology of hepatocellular carcinoma. Cancer. 1988 May 15;61(10):1942–1956. doi: 10.1002/1097-0142(19880515)61:10<1942::aid-cncr2820611003>3.0.co;2-j. [DOI] [PubMed] [Google Scholar]
  4. Bloom B. S., Hillman A. L., Fendrick A. M., Schwartz J. S. A reappraisal of hepatitis B virus vaccination strategies using cost-effectiveness analysis. Ann Intern Med. 1993 Feb 15;118(4):298–306. doi: 10.7326/0003-4819-118-4-199302150-00009. [DOI] [PubMed] [Google Scholar]
  5. Chu C. M., Sheen I. S., Lin S. M., Liaw Y. F. Sex difference in chronic hepatitis B virus infection: studies of serum HBeAg and alanine aminotransferase levels in 10,431 asymptomatic Chinese HBsAg carriers. Clin Infect Dis. 1993 May;16(5):709–713. doi: 10.1093/clind/16.5.709. [DOI] [PubMed] [Google Scholar]
  6. Dobson S., Scheifele D., Bell A. Assessment of a universal, school-based hepatitis B vaccination program. JAMA. 1995 Oct 18;274(15):1209–1213. [PubMed] [Google Scholar]
  7. Iwarson S., Jilg W., Stroffolini T. Substantial decline of notified hepatitis B in major parts of Europe after 1985. Scand J Infect Dis. 1994;26(1):19–22. doi: 10.3109/00365549409008585. [DOI] [PubMed] [Google Scholar]
  8. Krahn M., Detsky A. S. Should Canada and the United States universally vaccinate infants against hepatitis B? A cost-effectiveness analysis. Med Decis Making. 1993 Jan-Mar;13(1):4–20. doi: 10.1177/0272989X9301300103. [DOI] [PubMed] [Google Scholar]
  9. Krahn M., Gafni A. Discounting in the economic evaluation of health care interventions. Med Care. 1993 May;31(5):403–418. doi: 10.1097/00005650-199305000-00003. [DOI] [PubMed] [Google Scholar]
  10. Margolis H. S., Coleman P. J., Brown R. E., Mast E. E., Sheingold S. H., Arevalo J. A. Prevention of hepatitis B virus transmission by immunization. An economic analysis of current recommendations. JAMA. 1995 Oct 18;274(15):1201–1208. [PubMed] [Google Scholar]
  11. Max W., Rice D. P., MacKenzie E. J. The lifetime cost of injury. Inquiry. 1990 Winter;27(4):332–343. [PubMed] [Google Scholar]
  12. McQuillan G. M., Townsend T. R., Fields H. A., Carroll M., Leahy M., Polk B. F. Seroepidemiology of hepatitis B virus infection in the United States. 1976 to 1980. Am J Med. 1989 Sep 4;87(3A):5S–10S. doi: 10.1016/0002-9343(89)90523-8. [DOI] [PubMed] [Google Scholar]
  13. Mulley A. G., Silverstein M. D., Dienstag J. L. Indications for use of hepatitis B vaccine, based on cost-effectiveness analysis. N Engl J Med. 1982 Sep 9;307(11):644–652. doi: 10.1056/NEJM198209093071103. [DOI] [PubMed] [Google Scholar]
  14. Naylor C. D., Williams J. I., Basinski A., Goel V. Technology assessment and cost-effectiveness analysis: misguided guidelines? CMAJ. 1993 Mar 15;148(6):921–924. [PMC free article] [PubMed] [Google Scholar]
  15. Sherman M., Peltekian K. M., Lee C. Screening for hepatocellular carcinoma in chronic carriers of hepatitis B virus: incidence and prevalence of hepatocellular carcinoma in a North American urban population. Hepatology. 1995 Aug;22(2):432–438. [PubMed] [Google Scholar]
  16. Sobeslavský O. Prevalence of markers of hepatitis B virus infection in various countries: a WHO collaborative study. Bull World Health Organ. 1980;58(4):621–628. [PMC free article] [PubMed] [Google Scholar]
  17. Wong J. B., Koff R. S., Tinè F., Pauker S. G. Cost-effectiveness of interferon-alpha 2b treatment for hepatitis B e antigen-positive chronic hepatitis B. Ann Intern Med. 1995 May 1;122(9):664–675. doi: 10.7326/0003-4819-122-9-199505010-00004. [DOI] [PubMed] [Google Scholar]

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