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Cost-utility of universal hepatitis A vaccination in Canada.
Vaccine. 2007 Dec 12; 25(51):8536-48.V

Abstract

Hepatitis A (HA) vaccination in Canada is currently targeted toward high-risk groups. The cost-effectiveness and expected health outcomes of universal vaccination relative to targeted vaccination in low-incidence countries such as Canada are currently unknown. Here, we conducted a cost-utility analysis for this situation, with Canada as the study population. We included vaccine costs, time costs, infection costs, and public health costs. We assessed a range of possible universal vaccination strategies over an 80-year time horizon using multiple cost perspectives. A dynamic model was used to account for herd immunity. Aggregate health gains from switching to universal vaccination are modest (10-30 QALYs per year). However, a "9+9" strategy that replaces two doses of monovalent hepatitis B (HB) vaccine at 9/10 years (universally administered in most provinces) with two doses of bivalent HA/HB vaccine is cost-saving from the societal perspective. At a willingness to pay threshold of $50,000/QALY, mean net benefit is +49.4 QALYs (S.D. 12.6) from the societal perspective and +3.8 QALYS (S.D. 3.0) from the payer perspective for the "9+9" strategy. Net benefit from the payer perspective is sensitive to the marginal cost of HA/HB vaccine relative to HB vaccine. Similar conclusions may apply in other countries with low incidence and a targeted vaccination policy.

Authors+Show Affiliations

University of Guelph, Department of Mathematics and Statistics, Guelph, Ontario, Canada. cbauch@uoguelph.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17996339

Citation

Bauch, C T., et al. "Cost-utility of Universal Hepatitis a Vaccination in Canada." Vaccine, vol. 25, no. 51, 2007, pp. 8536-48.
Bauch CT, Anonychuk AM, Pham BZ, et al. Cost-utility of universal hepatitis A vaccination in Canada. Vaccine. 2007;25(51):8536-48.
Bauch, C. T., Anonychuk, A. M., Pham, B. Z., Gilca, V., Duval, B., & Krahn, M. D. (2007). Cost-utility of universal hepatitis A vaccination in Canada. Vaccine, 25(51), 8536-48.
Bauch CT, et al. Cost-utility of Universal Hepatitis a Vaccination in Canada. Vaccine. 2007 Dec 12;25(51):8536-48. PubMed PMID: 17996339.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-utility of universal hepatitis A vaccination in Canada. AU - Bauch,C T, AU - Anonychuk,A M, AU - Pham,B Z, AU - Gilca,V, AU - Duval,B, AU - Krahn,M D, Y1 - 2007/10/23/ PY - 2007/05/07/received PY - 2007/10/02/revised PY - 2007/10/02/accepted PY - 2007/11/13/pubmed PY - 2008/4/1/medline PY - 2007/11/13/entrez SP - 8536 EP - 48 JF - Vaccine JO - Vaccine VL - 25 IS - 51 N2 - Hepatitis A (HA) vaccination in Canada is currently targeted toward high-risk groups. The cost-effectiveness and expected health outcomes of universal vaccination relative to targeted vaccination in low-incidence countries such as Canada are currently unknown. Here, we conducted a cost-utility analysis for this situation, with Canada as the study population. We included vaccine costs, time costs, infection costs, and public health costs. We assessed a range of possible universal vaccination strategies over an 80-year time horizon using multiple cost perspectives. A dynamic model was used to account for herd immunity. Aggregate health gains from switching to universal vaccination are modest (10-30 QALYs per year). However, a "9+9" strategy that replaces two doses of monovalent hepatitis B (HB) vaccine at 9/10 years (universally administered in most provinces) with two doses of bivalent HA/HB vaccine is cost-saving from the societal perspective. At a willingness to pay threshold of $50,000/QALY, mean net benefit is +49.4 QALYs (S.D. 12.6) from the societal perspective and +3.8 QALYS (S.D. 3.0) from the payer perspective for the "9+9" strategy. Net benefit from the payer perspective is sensitive to the marginal cost of HA/HB vaccine relative to HB vaccine. Similar conclusions may apply in other countries with low incidence and a targeted vaccination policy. SN - 0264-410X UR - https://www.unboundmedicine.com/medline/citation/17996339/Cost_utility_of_universal_hepatitis_A_vaccination_in_Canada_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0264-410X(07)01139-5 DB - PRIME DP - Unbound Medicine ER -