Indications for Use of Hepatitis B Vaccine, Based on Cost-Effectiveness Analysis

TLDR

The study aims to determine cost‑effective indications for hepatitis B vaccination by comparing universal vaccination, screening‑then‑vaccination, and passive immunization strategies. The authors modeled hepatitis B attack rates, immunity prevalence, and exposure frequency in homosexual men, surgical residents, and the U.S. general population to evaluate the three vaccination strategies.

Abstract

To formulate indications for the use of hepatitis B vaccine, we examined the cost effectiveness of three strategies: vaccinating everyone; screening everyone and vaccinating those without evidence of immunity; and neither vaccinating nor screening, but passively immunizing those with known exposure. Estimates of the hepatitis attack rate, prevalence of immunity, and frequency of known exposure were made for three representative populations: homosexual men, surgical residents, and the general population of the United States. Screening followed by vaccination of homosexual men and vaccination without prior screening of surgical residents would result in savings of medical costs. Neither screening nor vaccination is the lowest-cost strategy for the general population. Vaccination of susceptible persons will save medical costs for populations with annual attack rates above 5 per cent. Vaccination may be considered cost effective (or cost saving when indirect costs are included) for populations with attack rates as low as 1 to 2 per cent.