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Is travel prophylaxis worth while? Economic appraisal of prophylactic measures against malaria, hepatitis A, and typhoid in travellers.
BMJ. 1994 Oct 08; 309(6959):918-22.BMJ

Abstract

OBJECTIVES

To estimate the costs and benefits of prophylaxis against travel acquired malaria, typhoid fever, and hepatitis A in United Kingdom residents during 1991.

DESIGN

Retrospective analysis of national epidemiological and economic data.

MAIN OUTCOME MEASURES

Incidence of travel associated infections in susceptible United Kingdom residents per visit; costs of prophylaxis provision from historical data; benefits to the health sector, community, and individuals in terms of avoided morbidity and mortality based on hospital and community costs of disease.

RESULTS

The high incidence of imported malaria (0.70%) and the low costs of providing chemoprophylaxis resulted in a cost-benefit ratio of 0.19 for chloroquine and proguanil and 0.57 for a regimen containing mefloquine. Hepatitis A infection occurred in 0.05% of visits and the cost of prophylaxis invariably exceeded the benefits for immunoglobulin (cost-benefit ratio 5.8) and inactivated hepatitis A vaccine (cost-benefit ratio 15.8). Similarly, low incidence of typhoid (0.02%) and its high cost gave whole cell killed, polysaccharide Vi, and oral Ty 21a typhoid vaccines cost-benefit ratios of 18.1, 18.0, and 22.0 respectively.

CONCLUSIONS

Fewer than one third of travellers receive vaccines but the total cost of providing typhoid and hepatitis A prophylaxis of 25.8m pounds is significantly higher than the treatment costs to the NHS (1.03m pounds) of cases avoided by prophylaxis. Neither hepatitis A prophylaxis nor typhoid prophylaxis is cost effective, but costs of treating malaria greatly exceed costs of chemoprophylaxis, which is therefore highly cost effective.

Authors+Show Affiliations

Hospital for Tropical Diseases Travel Clinic, London.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

7726905

Citation

Behrens, R H., and J A. Roberts. "Is Travel Prophylaxis Worth While? Economic Appraisal of Prophylactic Measures Against Malaria, Hepatitis A, and Typhoid in Travellers." BMJ (Clinical Research Ed.), vol. 309, no. 6959, 1994, pp. 918-22.
Behrens RH, Roberts JA. Is travel prophylaxis worth while? Economic appraisal of prophylactic measures against malaria, hepatitis A, and typhoid in travellers. BMJ. 1994;309(6959):918-22.
Behrens, R. H., & Roberts, J. A. (1994). Is travel prophylaxis worth while? Economic appraisal of prophylactic measures against malaria, hepatitis A, and typhoid in travellers. BMJ (Clinical Research Ed.), 309(6959), 918-22.
Behrens RH, Roberts JA. Is Travel Prophylaxis Worth While? Economic Appraisal of Prophylactic Measures Against Malaria, Hepatitis A, and Typhoid in Travellers. BMJ. 1994 Oct 8;309(6959):918-22. PubMed PMID: 7726905.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Is travel prophylaxis worth while? Economic appraisal of prophylactic measures against malaria, hepatitis A, and typhoid in travellers. AU - Behrens,R H, AU - Roberts,J A, PY - 1994/10/8/pubmed PY - 1994/10/8/medline PY - 1994/10/8/entrez SP - 918 EP - 22 JF - BMJ (Clinical research ed.) JO - BMJ VL - 309 IS - 6959 N2 - OBJECTIVES: To estimate the costs and benefits of prophylaxis against travel acquired malaria, typhoid fever, and hepatitis A in United Kingdom residents during 1991. DESIGN: Retrospective analysis of national epidemiological and economic data. MAIN OUTCOME MEASURES: Incidence of travel associated infections in susceptible United Kingdom residents per visit; costs of prophylaxis provision from historical data; benefits to the health sector, community, and individuals in terms of avoided morbidity and mortality based on hospital and community costs of disease. RESULTS: The high incidence of imported malaria (0.70%) and the low costs of providing chemoprophylaxis resulted in a cost-benefit ratio of 0.19 for chloroquine and proguanil and 0.57 for a regimen containing mefloquine. Hepatitis A infection occurred in 0.05% of visits and the cost of prophylaxis invariably exceeded the benefits for immunoglobulin (cost-benefit ratio 5.8) and inactivated hepatitis A vaccine (cost-benefit ratio 15.8). Similarly, low incidence of typhoid (0.02%) and its high cost gave whole cell killed, polysaccharide Vi, and oral Ty 21a typhoid vaccines cost-benefit ratios of 18.1, 18.0, and 22.0 respectively. CONCLUSIONS: Fewer than one third of travellers receive vaccines but the total cost of providing typhoid and hepatitis A prophylaxis of 25.8m pounds is significantly higher than the treatment costs to the NHS (1.03m pounds) of cases avoided by prophylaxis. Neither hepatitis A prophylaxis nor typhoid prophylaxis is cost effective, but costs of treating malaria greatly exceed costs of chemoprophylaxis, which is therefore highly cost effective. SN - 0959-8138 UR - https://www.unboundmedicine.com/medline/citation/7726905/Is_travel_prophylaxis_worth_while_Economic_appraisal_of_prophylactic_measures_against_malaria_hepatitis_A_and_typhoid_in_travellers_ L2 - https://www.bmj.com/lookup/pmidlookup?view=long&pmid=7726905 DB - PRIME DP - Unbound Medicine ER -