Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-29T01:41:28.605Z Has data issue: false hasContentIssue false
  • English
  • Français

Cost-Effectiveness of Ensuring Hepatitis B Protection for Previously Vaccinated Healthcare Personnel

Published online by Cambridge University Press:  10 May 2016

Thomas J. Hoerger ,
Christina Bradley ,
Sarah F. Schillie ,
Meredith Reilly  and
Trudy V. Murphy
Thomas J. Hoerger*
Affiliation:
RTI International, Research Triangle Park, North Carolina
Christina Bradley
Affiliation:
RTI International, Research Triangle Park, North Carolina
Sarah F. Schillie
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
Meredith Reilly
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
Trudy V. Murphy
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
*
RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709 ([email protected]).
Get access Rights & Permissions [Opens in a new window]

Extract

Objective

To examine the cost-effectiveness of pre- and postexposure approaches for ensuring hepatitis B protection among previously vaccinated healthcare personnel (HCP).

Design

A decision-analytic model was developed for alternative strategies of ensuring hepatitis B protection under assumptions of 68% and 95% long-term protection after a primary vaccination series. Costs and quality-adjusted life years (QALYs) lost from infections were estimated, and incremental cost-effectiveness ratios (ICERs) were calculated relative to a no intervention alternative over 10 years of intervention. Separate analyses were performed for trainees and nontrainees, using the healthcare system perspective. Trainees face higher risk of exposure and likely received primary vaccination as infants.

Setting

General healthcare settings.

Participants

Trainee and nontrainee HCP.

Interventions

Preexposure testing for antibody to hepatitis B surface antigen followed by additional vaccination for HCP without protective antibody levels; postexposure evaluation and management for HCP reporting blood or body fluid exposures

Results

The preexposure strategy prevents more infections and has higher costs than the postexposure strategy or no intervention. For trainees, 10-year preexposure evaluation ICERs are $832,875 and $144,457 per QALY for 95% and 68% long-term vaccine protection, respectively. Trainee 10-year postexposure evaluation ICERs are $1,146,660 and $191,579 per QALY under the 95% and 68% long-term protection assumptions, respectively. For nontrainees, 10-year ICERs are $745,739 and $1,129,286 per QALY for the preexposure and postexposure evaluation strategies, respectively.

Conclusions

ICERs may inform decision makers as they decide whether the added cost of the preexposure strategy provides sufficient value in preventing infections.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 7 , July 2014 , pp. 845 - 854
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. New York Center for Health Workforce Studies. The United States Health Workforce Profile: October 2006. Rensselaer, NY: New York Center for Health Workforce Studies, 2006. http://bhpr.hrsa.gov/healthworkforce/reports/ushealthwork2006.pdf.Google Scholar
2. Centers for Disease Control and Prevention. Updated U.S. public health service guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis. MMWR Morb Mortal Wkly Rep 2001;50(RR-11):1–52.Google Scholar
3. Centers for Disease Control and Prevention. CDC guidance for evaluating health-care personnel for hepatitis B virus protection and for administering postexposure management. MMWR Morb Mortal Wkly Rep 2013;62(RR-10);1–19.Google Scholar
4. Centers for Disease Control and Prevention. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP): part II: immunization of adults. MMWR Morb Mortal Wkly Rep 2006;55(RR-16):1–33.Google Scholar
5. Lu, P-J, Byrd, KK, Murphy, TV, Weinbaum, C. Hepatitis B vaccination coverage among high-risk adults 18–49 years, U.S. 2009. Vaccine 2011;29:7049–7057.CrossRefGoogle ScholarPubMed
6. Beltrami, EM, Williams, IT, Shapiro, CN, Chamberland, ME. Risk and management of blood-borne infections in health care workers. Clin Microbiol Rev 2000;13(3):385–407.Google Scholar
7. Centers for Disease Control and Prevention (CDC). Viral Hepatitis Surveillance—United States, 2010. Atlanta: CDC, 2012. http://www.cdc.gov/hepatitis/Statistics/2010Surveillance/index.htm.Google Scholar
8. McMahon, BJ, Dentinger, CM, Bruden, D, et al. Antibody levels and protection after hepatitis B vaccine: results of a 22-year follow-up study and response to a booster dose. J Infect Dis 2009;200:1390–1396.CrossRefGoogle ScholarPubMed
9. Poovorawan, Y, Chongsrisawat, V, Theamboonlers, A, et al. Evidence of protection against clinical and chronic hepatitis B infection 20 years after infant vaccination in a high endemicity region. J Viral Hepat 2011;18(5):369–375.Google Scholar
10. Zhu, CL, Liu, P, Chen, T, et al. Presence of immune memory and immunity to hepatitis B virus in adults after neonatal hepatitis B vaccination. Vaccine 2011;29(44):7835–7841.CrossRefGoogle ScholarPubMed
11. Centers for Disease Control and Prevention. Hepatitis B virus: a comprehensive strategy for eliminating transmission in the United States through universal childhood vaccination: recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR Recomm Rep 1991;40(RR-13):1–25.Google Scholar
12. Zhou, F, Euler, GL, McPhee, SJ, et al. Economic analysis of promotion of hepatitis B vaccination among Vietnamese-American children and adolescents in Houston and Dallas. Pediatrics 2003;111(6):1289–1296.Google Scholar
13. Margolis, HS, Coleman, PJ, Brown, RE, Mast, EE, Sheingold, SH, Arevalo, JA. Prevention of hepatitis B virus transmission by immunization: an economic analysis of current recommendations. JAMA 1995;274(15):1201–1208.Google Scholar
14. Kessler, CS, McGuinn, M, Spec, A, et al. Underreporting of blood and bodily fluid exposures among health care students and trainees in the acute care setting: a 2007 survey. Am J Infect Control 2011;39:129–134.CrossRefGoogle Scholar
15. Averhoff, F, Mahoney, F, Coleman, P, Schatz, G, Hurwitz, E, Margolis, H. Immunogenicity of hepatitis B vaccines: implications for persons at occupational risk of hepatitis B virus infection. Am J Prev Med 1998;15(1):1–8.CrossRefGoogle ScholarPubMed
16. Schillie, SF, Murphy, TV. Seroprotection after recombinant hepatitis B vaccination among newborn infants: a review. Vaccine 2013;31:2506–2516.CrossRefGoogle ScholarPubMed
17. McMahon, BJ, Bruden, DL, Petersen, KM, et al. Antibody levels and protection after hepatitis B vaccination: results of a 15-year follow-up. Ann Intern Med 2005;142:333–341.Google Scholar
18. McMahon, BJ. 30 year follow-up after hepatitis B vaccination in adults and children. In: Viral Hepatitis Prevention Board Meeting; November 2011; Milan.Google Scholar
19. Williams, JL, Christensen, CJ, McMahon, BJ, et al. Evaluation of the response to a booster dose of hepatitis B vaccine in previously immunized healthcare workers. Vaccine 2001;19:4081–4085.Google Scholar
20. Williams, RE. Hepatitis B vaccination coverage among students at a U.S. health science graduate school. In: National Immunization Conference; March 30, 2011; Washington, DC.Google Scholar
21. Maynard, J. Passive immunization against hepatitis B: review of recent studies and comment on current aspects of control. Am J Epidemiol 1978;107:77–86.Google Scholar
22. McMahon, BJ, Schoenberg, S, Bulkow, L, et al. Seroprevalence of hepatitis B viral markers in 52,000 Alaska natives. Am J Epidemiol 1993;138(7):544–549.CrossRefGoogle Scholar
23. Cruz, AC, Frentzen, BH, Behnke, M. Hepatitis B: a case for prenatal screening of all patients. Am J Ob Gyn 1987:156(5):1180–1183.Google Scholar
24. Friedman, SM, DeSilva, LP, Fox, HE, et al. Hepatitis B screening in a New York City obstetrics service. Am J Public Health 1988;78(3):308–310.Google Scholar
25. Kohn, MA, Farley, TA, Scott, C. The need for more aggressive follow-up of children born to hepatitis B surface antigen-positive mothers: lessons from the Louisiana Perinatal Hepatitis Immunization Program. Pediatr Infect Dis J 1996;15(6):535–540.Google Scholar
26. Kumar, ML, Dawson, NV, McCullough, AJ, et al. Should all pregnant women be screened for hepatitis B? Ann Intern Med 1987;107(3):273–277.Google Scholar
27. Miriti, MK, Billah, K, Weinbaum, C, et al. Economic benefits of hepatitis B vaccination at sexually transmitted disease clinics in the U.S. Public Health Rep 2008;123:504–513.CrossRefGoogle ScholarPubMed
28. Centers for Disease Control and Prevention (CDC). CDC Vaccine Price List: Adult Vaccine Price List. Atlanta: CDC, 2011. http://www.cdc.gov/vaccines/programs/vfc/awardees/vaccine-management/price-list/index.html. Accessed April 20, 2011.Google Scholar
29. Lee, JM, Botteman, M, Xanthakos, N, Nicklasson, L. Needlestick injuries in the United States: epidemiologic, economic, and quality of life issues. AAOHN J 2005;53(3):117–133.CrossRefGoogle ScholarPubMed
30. Centers for Disease Control and Prevention (CDC). HBIG Product Information. Atlanta: CDC, 2010. http://www.cdc.gov/hepatitis/PDFs/HBIG_Products&Distributors.pdf. Accessed September 28, 2012.Google Scholar
31. Gold, MR, Siegel, JE, Russell, LB, Weinstein, MC. Cost-Effectiveness in Health and Medicine. New York: Oxford University Press, 1996.Google Scholar
32. Lu, C-Y, Ni, Y-H, Chiang, B-L, et al. Humoral and cellular immune responses to a hepatitis B vaccine booster 15–18 years after neonatal immunization. J Infect Dis 2008;197:1419–1426.Google Scholar
33. Grosse, SG. Assessing cost-effectiveness in healthcare: history of the $50,000 per QALY threshold. Expert Rev Pharmacoecon Outcomes Res 2008;8(2):165–178.CrossRefGoogle Scholar
34. Agerton, TB, Mahoney, FJ, Polish, LB, Shapiro, CN. Impact of the bloodborne pathogens standard on vaccination of healthcare workers with hepatitis B vaccine. Infect Control Hosp Epidemiol 1995;16:287–291.CrossRefGoogle ScholarPubMed
35. Lu, P-J, Euler, GL. Influenza, hepatitis B, and tetanus vaccination coverage among health care personnel in the United States. Am J Infect Control 2011;39(6):488–494.Google Scholar
36. Reilly, M. Evidence for cost-effectiveness analysis: non-cost related model inputs. In: Advisory Committee for Immunization Practices; June 20, 2012; Atlanta.Google Scholar
37. Spradling, PR, Xing, J, Williams, R, et al. Immunity to hepatitis B virus (HBV) infection two decades after implementation of universal infant HBV vaccination: association of detectable residual antibodies and response to a single HBV challenge dose. Clin Vaccine Immunol 2013;20(4):559–561.CrossRefGoogle ScholarPubMed
38. Kim, S-Y, Billah, K, Lieu, TA, Weinstein, MC. Cost-effectiveness of hepatitis B vaccination at HIV counseling and testing sites. Am J Prev Med 2006;30(6):498–506.Google Scholar
39. Institute of Medicine. Adverse Effects of Vaccines: Evidence and Causality. Washington, DC: National Academies Press, 2011.Google Scholar