Vaccination of Sexually Active Homosexual Men Against Hepatitis A: Analysis of Costs and Benefits

Abstract

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.

Cost effectiveness outcomes research hepatitis A vaccination decision analysis disease prevention 

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REFERENCES

  1. 1.
    Hoybye G, Skinhoj P, Hentzer B, Faber V, Mathiesen LR. An epidemic of acute viral hepatitis in male homosexuals. Scand J Infect Dis 1980;12:241–44.PubMedGoogle Scholar
  2. 2.
    Christensen B, Brostrom CH, Bottiger M, Hermanson J, Weiland O, Ryd G, Berg JV, Sjoblom R. An epidemic outbreak of hepatitis A among homosexual men in Stockholm. Am J Epidemiol 1982;116:599–607.PubMedGoogle Scholar
  3. 3.
    Kosatsky T, Middaugh JP. Linked outbreaks of hepatitis A in homosexuals and in food service patrons and employees. West J Med 1986;144:307–10.PubMedGoogle Scholar
  4. 4.
    Centers for Disease Control and Prevention. Hepatitis A among homosexual men—United States, Canada and Australia. MMWR Morb Mortal Wkly Rep 1992;41:155–64.Google Scholar
  5. 5.
    Henning KJ, Bell E, Braun J, Barker ND. A community-wide outbreak of hepatitis A: risk factors for infection among homosexual and bisexual men. Am J Med 1995;99:132–36.PubMedGoogle Scholar
  6. 6.
    Corey L, Holmes KK. Sexual transmission of hepatitis A in homosexual men: incidence and mechanism. N Engl J Med 1980;302:435–38.PubMedGoogle Scholar
  7. 7.
    Coutinho RA, Albrecht-Van Lent P, Nelie N, Nagelkerke N, Kuipers H, Rijsdijk T. Prevalence and incidence of hepatitis A among male homosexuals. BMJ 1983;287:1743–45.PubMedGoogle Scholar
  8. 8.
    Katz MH, Hsu L, Wong E, Liska S, Anderson L, Janssen RS. Seroprevalence of and risk factors for hepatitis A infection among young homosexual and bisexual men. J Infect Dis 1997;175:1225–29.PubMedGoogle Scholar
  9. 9.
    Hadler SC. Global impact of hepatitis A virus infection: changing patterns. In: Hollinger FB, Lemon SM, Margolis HS, editors. Viral Hepatitis and Liver Disease. Baltimore, MD: Williams & Wilkins, 1991:14–19.Google Scholar
  10. 10.
    O'Grady J. Management of acute and fulminate hepatitis A. Vaccine 1992;10(Suppl 1):S21–23.PubMedGoogle Scholar
  11. 11.
    O'Grady JG, Alexander GJ, Hayllar KM, Williams R. Early indicators of prognosis in fulminant hepatic failure. Gastroenterology 1989;97:439–45.PubMedGoogle Scholar
  12. 12.
    Lemmon SM. Inactivated hepatitis A vaccines. JAMA 1994;271:1363–64.PubMedGoogle Scholar
  13. 13.
    Innis BL, Snitbhan R, Kunasol P, Laorakpongse T, Poopantanakool W, Kozik CA, Suntayakorn S, Suknuntapong T, Safary A, Tang DB, Boslego JW. Protection against hepatitis A by an inactiviated vaccine in healthy children. JAMA 1994;271:1328–34.PubMedGoogle Scholar
  14. 14.
    Werzberger A, Mensch B, Kuter B, Brown L, Lewis J, Sitrin R, Miller W, Shouval D, Wiens B, Calandra G, Ryan J, Provost P, Nalin D. A controlled trial of a formalin-inactivated hepatitis A vaccine in healthy children. N Engl J Med 1992;327:453–57.PubMedGoogle Scholar
  15. 15.
    Briem H, Safary A. Immunogenicity and safety in adults of hepatitis A vaccine administered as a single dose with a booster 6 months later. J Med Virol 1994;44:446–51.PubMedGoogle Scholar
  16. 16.
    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 Morbid Mortal Wkly Rep 1996;45(RR-15):4–5.Google Scholar
  17. 17.
    Lipscomb J, Weinstein MC, Torrance GW. Time preference. In: Gold GR, Seigel JE, Russell LB, Weinstein MC, editors. Cost-Effectiveness in Health and Medicine. Oxford: Oxford University Press, 1996;214–35.Google Scholar
  18. 18.
    Fink A, Kosecoff J, Chassin M, Brook RH. Consensus methods: characteristics and guidelines for use. Am J Public Health 1984;74:979–83.PubMedGoogle Scholar
  19. 19.
    Jones J, Hunter D. Consensus methods for medical and health services research. BMJ 1995;311:376–80.PubMedGoogle Scholar
  20. 20.
    Steffen R, Rickenbach M, Wilheim U, Helminger A, Schär M. Health problems after travel to developing countries. J Infect Dis 1987;156:84–91.PubMedGoogle Scholar
  21. 21.
    Koff RS. Preventing hepatitis A infections in travelers to endemic areas. Am J Trop Med Hyg 1995;53:586–90.PubMedGoogle Scholar
  22. 22.
    Alter MJ, Mast EE. The epidemiology of viral hepatitis in the United States. Gastroenterol Clin N Am 1994;23:437–54.Google Scholar
  23. 23.
    Lednar WM, Lemmon SM, Kirkpatrick JW, Redfield RR, Fields ML, Kelley PW. Frequency of illness associated with epidemic hepatitis A virus infections in adults. Am J Epidemiol 1985;122:226–33.PubMedGoogle Scholar
  24. 24.
    Villarejos VM, Serra JC, Anderson-Visona K, Mosley JW. Hepatitis A virus infection in households. Am J Epidemiol 1982;115:577–86.PubMedGoogle Scholar
  25. 25.
    Hepatitis Surveillance Report No 55. Atlanta, GA: Centers for Disease Control and Prevention, 1994.Google Scholar
  26. 26.
    Hepatitis Surveillance Report No 56. Atlanta, GA: Centers for Disease Control and Prevention, 1995.Google Scholar
  27. 27.
    McNeil M, Hoy JK, Richards MJ, Lehmann NI, Dimirikakis M, Gus ID, Lucas CR. Aetiology of fatal viral hepatitis in Melbourne: a retrospective study. Med J Aust 1984;141:637–40.PubMedGoogle Scholar
  28. 28.
    Papaevangelou G, Tassopoulos N, Roumeliotou-Karayannis A, Richardson C. Etiology of fulminant viral hepatitis in Greece. Hepatology 1984;4:369–72.PubMedGoogle Scholar
  29. 29.
    Vento S, Garofano T, Renzini C, Cainelli F, Casali F, Ghironzi G, Ferraro T, Concia E. Fulminant hepatitis associated with hepatitis A virus superinfection in patients with chronic hepatitis C. N Engl J Med 1998;338:286–90.PubMedGoogle Scholar
  30. 30.
    Tilzey AJ, Banatvala JE: Hepatitis A: changing prevalence and possible vaccines. BMJ 1991;302:1552–53.PubMedGoogle Scholar
  31. 31.
    Van Doorslaer E, Tormans G, Van Damme P. Cost effectiveness analysis of vaccination against hepatitis A in travellers. J Med Virol 1994;44:463–69.PubMedGoogle Scholar
  32. 32.
    Sjögren MH, Tanno H, Fay O, Sileoni S, Cohen BO, Burke DS, Feighny RJ. Hepatitis A virus in stool during clinical relapse. Ann Intern Med 1987;106:221–26.PubMedGoogle Scholar
  33. 33.
    Glikson M, Galun E, Oren R, Tur-Kaspa R, Shouval D. Relapsing hepatitis A: review of 14 cases and literature survey. Medicine 1992;71:14–23.PubMedGoogle Scholar
  34. 34.
    Tong M, El-Farra EL, Grew MI. Clinical manifestations of hepatitis A: recent experience in a community teaching hospital. J Infect Dis 1995;171(Suppl 1):S15–18.PubMedGoogle Scholar
  35. 35.
    Cobden I, James O. A biphasic illness associated with acute hepatitis A virus infection. J Hepatol 1986;2:19–23.PubMedGoogle Scholar
  36. 36.
    Schiff ER. Atypical clinical manifestations of hepatitis A. Vaccine 10(Suppl 1):S18–20.Google Scholar
  37. 37.
    Huse DM, Meissner HC, Lacey MJ, Oster G. Childhood vaccination against chickenpox: an analysis of benefits and costs. J Pediatr 1994;124:869–74.PubMedGoogle Scholar
  38. 38.
    Margolis HS, Coleman PJ, Brown RE, Mast EE, Sheingold SH, Areval JA. Prevention of hepatitis B virus transmission by immunization: an economic analysis of current recommendations. JAMA 1995;274:1201–8.PubMedGoogle Scholar
  39. 39.
    Lieu TA, Cochi SL, Black SB, Halloran E, Shinefield HR, Holmes SJ, Wharton M, Washington E. Cost-effectiveness of a routine varicella vaccination program for US children. JAMA 1994;271:375–81.PubMedGoogle Scholar
  40. 40.
    Fee and Coding Standard: National Pricing Guide for Setting Fees—1997. Salt Lake City, UT: Medicode, 1997.Google Scholar
  41. 41.
    Hospital Statistics: The AHA Profile of United States Hospitals. Chicago, IL: American Hospital Association, 1996.Google Scholar
  42. 42.
    Hauboldt RH. Cost Implications of Human Organ Transplantation, An Update: 1993. Seattle, WA: Milliman & Robertson, 1993.Google Scholar
  43. 43.
    1996 Annual Report of the Scientific Registry for Transplant Recipients and the Organ Procurement and Transplantation Network—Transplant Data: 1988–1995. Richmond, VA: United Network for Organ Sharing, 1996.Google Scholar
  44. 44.
    Haddix AC, Shaffer PA. Cost-effectiveness analysis. In: Haddix AC, Teutsch SM, Shaffer PA, Duñet DO, editors. Prevention Effectiveness—A Guide to Decision Analysis and Economic Evaluation. Oxford: Oxford University Press, 1996;116–18.Google Scholar
  45. 45.
    Finkler SA. The distinction between cost and charges. Ann Intern Med 1982;96:102–109.PubMedGoogle Scholar
  46. 46.
    Tengs TO, Adams ME, Pliskin JS, Gelb-Safran D, Siegel JE, Weinstein MC Graham JD. Five-hundred life-saving interventions and their cost effectiveness. Risk Anal 1995;15:369–90.PubMedGoogle Scholar
  47. 47.
    Tucker AW, Haddix AC, Bresee JS, Holman RC, Parashar UD, Glass RI. Cost-effectiveness of a rotavirus immunization program for the United States. JAMA 1998;279:1371–76.PubMedGoogle Scholar
  48. 48.
    Goldman L, Gaber AM, Grover SA, Htalsky MA. Cost-effectiveness of assessment and management of risk factors. J Am Coll Cardiol 1996;27:1020–30.PubMedGoogle Scholar
  49. 49.
    Pearson TA. Lipid-lowering therapy in low risk patients. JAMA 1998;279:1659–61.PubMedGoogle Scholar
  50. 50.
    Russell LB, Gold MR, Siegel JE, Daniels N, Weinstein MC. The role of cost effectiveness analysis in health and medicine. JAMA 1996;276:1172–77.PubMedGoogle Scholar
  51. 51.
    Weinstein MC, Siegel JE, Gold ME, Kamlet MS, Russell LB. Recommendations of the panel on cost-effectiveness in health and medicine. JAMA 1996;276:1253–58.PubMedGoogle Scholar
  52. 52.
    Smith S, Weber S, Wiblin T, Nettleman M. Cost-effectiveness of hepatitis A vaccination in healthcare workers. Infect Control Hosp Epidemiol 1997;18:688–91.PubMedGoogle Scholar
  53. 53.
    Tormans G, Van Damme P, Van Doorslaer E. Cost effectiveness analysis of hepatitis A prevention in travellers. Vaccine 1992;10(Suppl 1):S88–92.PubMedGoogle Scholar

Copyright information

© Gay and Lesbian Medical Association 1999

Authors and Affiliations

  1. 1.Capitol Outcomes Research, Inc.Alexandria

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