Cost-effectiveness analysis of catch-up hepatitis A vaccination among unvaccinated/partially-vaccinated children

• Type of Material: Article
• Authors: Abigail Hankin-Wei, Emory University; David B. Rein, University of Chicago; Alfonso Hernandez-Romieu, Emory University; Mallory J. Kennedy, University of Chicago; Lisa Bulkow, Centers for Disease Control and Prevention (CDC); Eli Rosenberg, Emory University; Monica Trigg, Emory University; Noele P. Nelson, Centers for Disease Control and Prevention
• Language: English
• Date: 2016-07-29
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2016 Elsevier Ltd
• Final Published Version (URL): http://dx.doi.org/10.1016/j.vaccine.2016.06.040
• Title of Journal or Parent Work: Vaccine
• ISSN: 0264-410X
• Volume: 34
• Issue: 35
• Start Page: 4243
• End Page: 4249
• Grant/Funding Information: This works was supported by Cooperative Agreement Number 5U38PS004646 by the National Center for HIV, Viral Hepatitis, STD and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, as part of the NCHHSTP Epidemiologic and Economic Modeling Cooperative Agreement.; Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.
• Keywords: COVERAGE; MODEL; IMPACT; REFUSAL; OUTBREAK; ADULTS; Research & Experimental Medicine; INFECTIONS; DISEASE; HEALTH; Immunology; UNITED-STATES; Vaccine recommendation; Medicine, Research & Experimental; Hepatitis A; Science & Technology; Economic modeling; Life Sciences & Biomedicine
• Research Categories: Health Sciences, Immunology; Health Sciences, Public Health

Abstract

Background Since 2006, the US Centers for Disease Control and Prevention has recommended hepatitis A (HepA) vaccination routinely for children aged 12–23 months to prevent hepatitis A virus (HAV) infection. However, a substantial proportion of US children are unvaccinated and susceptible to infection. We present results of economic modeling to assess whether a one-time catch-up HepA vaccination recommendation would be cost-effective. Methods We developed a Markov model of HAV infection that followed a single cohort from birth through death (birth to age 95 years). The model compared the health and economic outcomes from catch-up vaccination interventions for children at target ages from two through 17 years vs. outcomes resulting from maintaining the current recommendation of routine vaccination at age one year with no catch-up intervention. Results Over the lifetime of the cohort, catch-up vaccination would reduce the total number of infections relative to the baseline by 741 while increasing doses of vaccine by 556,989. Catch-up vaccination would increase net costs by $10.2 million, or $2.38 per person. The incremental cost of HepA vaccine catch-up intervention at age 10 years, the midpoint of the ages modeled, was $452,239 per QALY gained. Across age-cohorts, the cost-effectiveness of catch-up vaccination is mo st favorable at age 12 years, resulting in an Incremental Cost-Effectiveness Ratio of $189,000 per QALY gained. Conclusions Given the low baseline of HAV disease incidence achieved by current vaccination recommendations, our economic model suggests that a catch-up vaccination recommendation would be less cost-effective than many other vaccine interventions, and that HepA catch-up vaccination would become cost effective at a threshold of $50,000 per QALY only when incidence of HAV rises about 5.0 cases per 100,000 population.