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August 2000

The Cost-effectiveness of Adolescent Hepatitis A Vaccination in States With the Highest Disease Rates

Author Affiliations

From Capitol Outcomes Research Inc, Alexandria, Va (Mr Jacobs), and Hepatitis Branch, Centers for Disease Control and Prevention, Atlanta, Ga (Drs Margolis and Coleman). Dr Coleman is now with the Office of Mine Safety and Health Research, National Institute for Occupational Safety and Health, Spokane, Wash. Mr Jacobs is a shareholder in Capitol Outcomes Research Inc, which has received research grants from SmithKline Beecham to investigate the costs of hepatitis A and the cost-effectiveness of vaccination. Dr Margolis is involved in a cooperative research and development agreement with SmithKline Beecham.

Arch Pediatr Adolesc Med. 2000;154(8):763-770. doi:10.1001/archpedi.154.8.763

Background  The Advisory Committee on Immunization Practices has recommended routine childhood hepatitis A vaccination in states and communities where the incidence of disease exceeds the national average, but most adolescents are currently unprotected from infection.

Objective  To estimate clinical and economic consequences of vaccinating adolescents against hepatitis A in the 10 states with the highest disease rates.

Design  Decision analysis was used to assess cost-effectiveness from societal and health system perspectives. Parameter estimates were obtained from national surveillance data, a study of hepatitis A cases, and an expert panel.

Main Outcome Measures  Reduction in disease incidence; costs of vaccination, treatment, and work loss; years of life saved (YOLS); and costs per YOLS.

Results  In states with the highest disease rates, vaccination of adolescents against hepatitis A would reduce the lifetime risk of symptomatic infection from 3.3% to 0.7% and prevent loss of 2117 years of life. Vaccination of a single birth cohort would cost $30.9 million, yet treatment and work loss costs would decline $14.2 million and $23.8 million, respectively. Hepatitis A vaccination would cost the health system $7902 per YOLS or $13,722 per discounted YOLS. Results are most sensitive to variation in the discount rate and assumptions regarding long-term vaccine protective efficacy.

Conclusions  Hepatitis A vaccination of adolescents in states with high disease rates would reduce costs to society. Although health system costs would increase, cost-effectiveness is comparable to other recommended vaccines and superior to many commonly used medical interventions.