Cost effectiveness of hepatitis B vaccination strategies in Ireland: an economic evaluation

• Published in: European journal of public health 2008-06, Vol.18 (3), p.275-282
• Main Authors: Tilson, Lesley, Thornton, Lelia, O’Flanagan, Darina, Johnson, Howard, Barry, Michael
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age Distribution; Aged; Asymptomatic; Babies; Child; Child Health Services; Child, Preschool; Cost analysis; Cost effectiveness; Cost estimates; Cost-Benefit Analysis; Disease prevention; economic; Epidemiology; Health economics; Health policy; Health services; Health surveillance; Hepatitis; Hepatitis B; Hepatitis B - economics; Hepatitis B - epidemiology; Hepatitis B - prevention & control; Hepatitis B Vaccines - administration & dosage; Hepatitis B Vaccines - economics; Hepatitis B virus; Humans; Immigrants; Immigration; Immunization; Incidence; Infant; Infant, Newborn; Infants; Infections; Ireland; Ireland - epidemiology; Laboratories; Markov Chains; Mass Vaccination - economics; Middle Aged; Models, Econometric; Noncitizens; Pharmacoeconomics; Population; Public health; Quality-Adjusted Life Years; Sensitivity analysis; Sexually transmitted diseases; STD; Teaching hospitals; Trends; vaccination; Vaccination and vaccines; Vaccines
• ISSN: 1101-1262; 1464-360X
• DOI: 10.1093/eurpub/ckm123

Background: In accordance with World Health Organization recommendations, many European countries have introduced universal hepatitis B vaccination policies. The UK and Ireland are exceptions. In this study, we conducted an economic evaluation of a universal infant hepatitis B vaccination programme, using a six-component vaccine, compared with the current selective strategy of vaccinating high-risk infants with a monovalent hepatitis B vaccine. Methods: A cost effectiveness analysis was conducted using a Markov model. The perspective of the analysis was the Irish Health Service Executive. Unit cost and resource utilization data were derived from expert clinical opinion, published sources, diagnosis-related group costs for hospital admissions and local cost estimates for medical fees and laboratory investigations. A full probabilistic sensitivity analysis was undertaken. Both costs and outcomes were modelled over a period of 80 years and discounted at 3.5%. Results: Assuming an incidence of acute hepatitis B virus (HBV) infection in Ireland of 8.4 per 100 000 population, the incremental cost effectiveness ratio ranged from €10 992/life years gained (LYG) to €67 200/LYG, at the lowest and highest price estimates for the six-component vaccine, respectively. The cost effectiveness of universal versus selective hepatitis B vaccination was sensitive to the risk of acute HBV infection, the cost of the universal infant vaccination programme and the discount rate. Conclusion: At a cost of €29.00 per dose of the six-component vaccine, universal infant hepatitis B vaccination is cost effective at €37 018/LYG. This compares favourably with other preventive programmes in Ireland.