Vaccination of Sexually Active Homosexual Men Against Hepatitis A: Analysis of Costs and Benefits
Objective: To estimate costs and benefits of vaccinating young homosexual men against hepatitis A. Design and setting: A decision-analytic model was used to assess vaccination from the societal perspective. Effects of vaccination at age 20 were modeled through each person's lifetime, with costs discounted at 3% annually. Intervention: Two doses of formalin-inactivated vaccine (Havrix, Smithkline Beecham Pharmaceuticals) administered by intramuscular injection 6–12 months apart. Results: Vaccination of 10,000 men would cost $959,000. Over the lifetimes of cohort members, hepatitis A-related hospitalizations would decline from 366 to 76, and treatment costs would decline from $2,577,000 to $363,000. Treatment cost reduction would fully offset vaccination costs within 10 years. Productivity losses associated with hepatitis A morbidity, primarily work absenteeism, would decline by $5,231,000. Vaccination would prevent an estimated 8.6 premature deaths, saving 213 life-years and $2,836,000 in mortality-related productivity losses. Results are only modestly affected when model assumptions are varied within plausible ranges. Conclusions: Hepatitis A vaccine provides improved patient outcomes and cost reduction. From a societal perspective, vaccination provides $10.72 in economic benefits for every $1 spent on vaccination. Physicians should counsel homosexual men to be vaccinated against hepatitis A. Health insurers would find it in their own financial interest to cover vaccination.
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