Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-09T22:52:23.407Z Has data issue: false hasContentIssue false
  • English
  • Français

Cost-Effectiveness of Hepatitis A–B Vaccine Versus Hepatitis B Vaccine for Healthcare and Public Safety Workers in the Western United States

Published online by Cambridge University Press:  02 January 2015

R. Jake Jacobs ,
Gene A. Gibson  and
Allen S. Meyerhoff
R. Jake Jacobs*
Affiliation:
Capitol Outcomes Research, Inc., Alexandria, Virginia
Gene A. Gibson
Affiliation:
Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
Allen S. Meyerhoff
Affiliation:
Capitol Outcomes Research, Inc., Alexandria, Virginia
*
Capitol Outcomes Research, Inc., 6188 Old Franconia Road, Alexandria, VA 22310
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To determine the cost-effectiveness of substituting hepatitis A–B vaccine for hepatitis B vaccine when healthcare and public safety workers in the western United States are immunized to protect against occupational exposures to hepatitis B.

Participants:

A cohort of 100,000 hypothetical healthcare and public safety workers from 11 western states with hepatitis A rates twice the national average.

Design:

A Markov model of hepatitis A was developed using estimates from U.S. government databases, published literature, and an expert panel. Added costs of hepatitis A–B vaccine were compared with savings from reduced hepatitis A treatment and work loss. Cost-effectiveness was expressed as the ratio of net costs to quality-adjusted life-years (QALYs) gained.

Results:

Substituting hepatitis A–B vaccine would prevent 29,796 work-loss–days, 222 hospitalizations, 6 premature deaths, and the loss of 214 QALYs. Added vaccination costs of $5.4 million would be more than offset by $1.9 million and $6.1 million reductions in hepatitis A treatment and work loss costs, respectively. Cost-effectiveness improves as the time horizon is extended, from $232,600 per QALY after 1 year to less than $0 per QALY within 11 years. Estimates are most sensitive to community-wide hepatitis A rates and the degree to which childhood vaccination may reduce future rates.

Conclusion:

For healthcare and public safety workers in western states, substituting hepatitis A–B vaccine for hepatitis B vaccine would reduce morbidity, mortality, and costs.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 7 , July 2004 , pp. 563 - 569
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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.Berge, JJ, Drennan, DP, Jacobs, RJ, et al.The cost of hepatitis A infections in American adolescents and adults in 1997. Hepatology 2000;31:469–473.CrossRefGoogle ScholarPubMed
2.Centers for Disease Control and Prevention. Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1999;48(RR-12):1–37.Google Scholar
3.Steffen, R, Rickenbach, M, Wilhelm, U, Helminger, A, Schar, M. Health problems after travel to developing countries. J Infect Dis 1987;156:84–91.CrossRefGoogle ScholarPubMed
4.Centers for Disease Control and Prevention. Hepatitis Surveillance Report Number 57. Atlanta, GA: Centers for Disease Control and Prevention; 2000.Google Scholar
5.Jacobs, RJ, Margolis, HS, Coleman, PJ. The cost-effectiveness of adolescent hepatitis A vaccination in states with the highest disease rates. Arch Pediatr Adolesc Med 2000;154:763–770.Google Scholar
6.Hadler, SC. Global impact of hepatitis A virus infection: changing patterns. In: Hollinger, FB, Lemon, SM, Margolis, HS, eds. Viral Hepatitis and Liver Disease. Baltimore, MD: Williams & Wilkins; 1991:14–19.Google Scholar
7.Doebbeling, BN, Ferguson, KJ, Kohout, FJ. Predictors of hepatitis B vaccine acceptance in health care workers. Med Care 1996;34:58–72.Google Scholar
8.Louther, J, Feldman, J, Rivera, P, Villa, N, DeHovitz, J, Sepkowitz, KA. Hepatitis B vaccination program at a New York City hospital: seroprevalence, seroconversion, and declination. Am J Infect Control 1998;26:423–427.Google Scholar
9.Jeffe, DB, Mutha, S, Kim, LE, Evanoff, BA, L'Ecuyer, PB, Fraser, VJ. Does clinical experience affect medical students' knowledge, attitudes, and compliance with universal precautions? Infect Control Hosp Epidemiol 1998;19:767–771.Google Scholar
10.Das, A. An economic analysis of different strategies of immunization against hepatitis A virus in developed countries. Hepatology 1999;29:548–552.Google Scholar
11.Jacobs, RJ, Meyerhoff, AS, Coleman, PJ, Margolis, HS. The cost effectiveness of vaccinating American children against hepatitis A. In: Margolis, HS, Alter, MJ, Liang, TJ, Deinstag, JL, eds. Viral Hepatitis and Liver Disease. London: International Medical Press; 2002:66–70.Google Scholar
12.O'Connor, JB, Imperiale, TF, Singer, ME. Cost-effectiveness analysis of hepatitis A vaccination strategies for adults. Hepatology 1999;30:1077–1081.Google Scholar
13.Smith, S, Weber, S, Wiblin, T, Nettleman, M. Cost-effectiveness of hepatitis A vaccination in healthcare workers. Infect Control Hosp Epidemiol 1997;18:688–691.Google Scholar
14.Armstrong, GL, Bell, BP. Hepatitis A virus infections in the United States: model-based estimates and implications for childhood immunization. Pediatrics 2002;109:839–845.Google Scholar
15.Rendi-Wagner, P, Kundi, M, Stemberger, H, et al.Antibody response to three recombinant hepatitis B vaccines: comparative evaluation of multicenter travel-clinic based experience. Vaccine 2001;19:2055–2060.CrossRefGoogle ScholarPubMed
16.Koff, RS, Chalmers, TC, Culhane, PO. Underreporting of viral hepatitis. Gastroenterology 1973;64:1194.Google Scholar
17.Maier, R. The reporting of communicable diseases. Am J Epidemiol 1977;105:587–590.Google Scholar
18.Mascola, L, Veza, M, Run, G, Buchholz, U, Peterson, CL. Hepatitis A incidence in Los Angeles County, California: prime profile for prevention. Presented at the 38th Annual Meeting of the Infectious Diseases Society of America; September 7-10, 2000; New Orleans, LA. Abstract 522.Google Scholar
19.Centers for Disease Control and Prevention. CDC Vaccine Price List, Prices Last Updated November 1, 2002. Atlanta, GA: Centers for Disease Control and Prevention; 2002. Available at www.cdc.gov/nip/vfc/cdc_vac_price_list.htm. Accessed November 15, 2002.Google Scholar
20.U.S. Bureau of Labor Statistics. 2000 National Occupational Employment and Wage Estimates. Washington, DC: U.S. Bureau of Labor Statistics; 2000. Available at www.bls.gov/oes/2000/oes_nat.htm. Accessed April 6, 2002.Google Scholar
21.American Hospital Association. Hospital Statistics: Emerging Trends in Hospitals. Chicago, IL: American Hospital Association; 1996.Google Scholar
22.Wiedermann, G, Kundi, M, Ambrosch, F, Safary, A, D'Hondt, E, Delem, A. Inactivated hepatitis A vaccine: long-term antibody persistence. Vaccine 1997;15:612–615.CrossRefGoogle ScholarPubMed
23.Anderson, RN, Kochanek, KD, Murphy, SL. Report of final mortality statistics, 1995. Monthly Vital Statistics Report 1997;45:1–13.Google Scholar
24.Jacobs, RJ, Moleski, RJ, Meyerhoff, AS. The value of hepatitis A prevention based on time tradeoff and willingness-to-pay measurement. Pharmacoeconomics 2002;20:739–747.Google Scholar
25.Hauboldt, RH. Cost Implications of Human Organ and Tissue Transplantations, An Update: 1999. Seattle, WA: Milliman & Robertson; 1999.Google Scholar
26.United Network for Organ Sharing. 1999 Annual Report of the US Scientific Registry of Transplant Recipients and the Organ Procurement and Transplantation Network: Transplant Data 1989-1998. Richmond, VA: United Network for Organ Sharing; 1999. Available at www.unos.org/data/anrpt_main.htm. Accessed August 16, 2002.Google Scholar
27.Walker, MAC, Bergman, BJ. Analyzing year-to-year changes in employer costs for employee compensation. Compensation and Working Conditions 1998:19–27.Google Scholar
28.Saunders, NC, Su, BW. The US Economy to 2008: A Decade of Continued Growth. Monthly Labor Review. Washington, DC: U.S. Bureau of Labor Statistics; 1999.Google Scholar
29.U.S. Bureau of Labor Statistics. Consumer Price Index: All Urban Consumers. Washington, DC: U.S. Bureau of Labor Statistics; 2002. Available at www.bls.gov/cpi/home.htm. Accessed April 6, 2002.Google Scholar
30.U.S. Bureau of Labor Statistics. National Compensation Survey: Compensation Cost Trends. Washington, DC: U.S. Bureau of Labor Statistics; 2002. Available at www.bls.gov/ect/home.htm. Accessed April 6, 2002.Google Scholar
31.Weinstein, MC, Siegel, JE, Gold, MR, Kamlet, MS, Russell, LB. Recommendations of the panel on cost-effectiveness in health and medicine. JAMA 1996;276:1253–1258.CrossRefGoogle ScholarPubMed
32.Jacobs, RJ, Greenberg, DP, Koff, RS, et al.Cost effectiveness of childhood hepatitis A vaccination: regional versus national strategies. Pediatr Infect Dis J 2003;22:904–914.CrossRefGoogle Scholar
33.U.S. Department of Labor. Bloodborne pathogens: the standard. 60 Federal Register 64175-64182 (1991).Google Scholar
34.Shapiro, CN. Occupational risk of infection with hepatitis B and C virus. Surg Clin North Am 1995;75:1047–1056.Google Scholar
35.Coleman, PJ, McQuillan, GM, Moyer, LA, Lambert, SB, Margolis, HS. Incidence of hepatitis B virus infection in the United States, 1976-1994: estimates from the National Health and Nutrition Examination Surveys. J Infect Dis 1998;178:954–959.Google Scholar
36.Stone, PW, Teutsch, S, Chapman, RH, Bell, C, Goldie, SJ, Beumann, PJ. Cost-utility analyses of clinical preventive services: published ratios, 1976-1997. Am J Prev Med 2000;19:15–23.Google Scholar
37.Laupacis, A, Feeny, D, Detsky, AS, Tugwell, PX. How attractive does a new technology have to be to warrant adoption and utilization? CMAJ 1992;146:473–481.Google Scholar
38.Klein, BS, Michaels, JA, Rytel, MW, Berg, KG, Davis, JP. Nosocomial hepatitis A: a multinursery outbreak in Wisconsin. JAMA 1984;252:2716–2721.Google Scholar
39.Rosenblum, LS, Villarino, ME, Nainan, OV, et al.Hepatitis A outbreak in a neonatal intensive care unit: risk factors for transmission and evidence of prolonged viral excretion among preterm infants. J Infect Dis 1991;164:476–482.Google Scholar
40.Doebbeling, BN, Li, N, Wenzel, RP. An outbreak of hepatitis A among health care workers: risk factors for transmission. Am J Public Health 1993;83:1679–1684.Google Scholar
41.Watson, JC, Fleming, DW, Borella, AJ, Olcott, ES, Conrad, RE, Baron, RC. Vertical transmission of hepatitis A resulting in an outbreak in a neonatal intensive care unit. J Infect Dis 1993;167:567–571.Google Scholar
42.Borg, MA, Portelli, A. Hospital laundry workers: an at-risk group for hepatitis A? Occup Med 1999;49:448–450.Google Scholar
43.Trevisan, A, Stocco, E, Fanelli, G, Bicciato, F, Paruzzolo, P. Seroprevalence of hepatitis A markers in subjects exposed to biological risk. Int Arch Occup Environ Health 1999;72:125–127.Google Scholar
44.Rudi, J, Toppe, H, Marx, N, et al.Risk of infection with Helicobacter pylori and hepatitis A virus in different groups of hospital workers. Am J Gastroenterol 1997;92:258–262.Google ScholarPubMed
45.Poole, CJ, Shakespeare, AT. Immunity to hepatitis A in paediatric and nursery nurses. Occup Med 1996;46:361–363.Google Scholar
46.Domart, M, Mlika-Cabanne, N, Henzel, D, et al.Hepatitis A among health workers in Paris hospitals. J Med Virol 1999;58:321–324.3.0.CO;2-#>CrossRefGoogle ScholarPubMed
47.Ruiz, JD, Molitor, F, McFarland, W, et al.Prevalence of HIV infection, sexually transmitted diseases, and hepatitis and related risk behavior in young women living in low-income neighborhoods of northern California. West J Med 2000;172:368–373.Google Scholar
48.Centers for Disease Control and Prevention. National, state and urban area vaccination coverage levels among children aged 19-35 months: United States, 2000. MMWR 2001;50:637–641.Google Scholar
49.Jacobs, RJ, Meyerhoff, AS. Effect of middle-school entry requirements on hepatitis B vaccination coverage. J Adolesc Health 2004;34:420–423.Google Scholar
50.Meyerhoff, AS, Jacobs, RJ. Cost effectiveness of pneumococcal vaccine. JAMA 2000;283:440.Google Scholar
51.Staes, CJ, Schlenker, TL, Risk, I, et al.Sources of infection among persons with acute hepatitis A and no identified risk factors during a sustained community-wide outbreak. Pediatrics 2000;106:E54.Google Scholar
52.Smith, PF, Grabau, JC, Werzberger, A, et al.The role of young children in a community-wide outbreak of hepatitis A. Epidemiol Infect 1997;118:243–252.Google Scholar
53.Averhoff, F, Shapiro, CN, Bell, BP, et al.Control of hepatitis A through routine vaccination of children. JAMA 2002;296:2968–2973.Google Scholar