Skip to main content
SpringerLink
Log in

Cost-Effectiveness Analysis of Hepatitis B Vaccination Strategies in Catalonia, Spain

  • Original Research Article
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Summary

Hepatitis B virus (HBV) infection is an important public health problem all over the world. Vaccination is one way to prevent it, and several strategies can be used depending on endemicity, the main pattern of HBV transmission and the demographic structure of the population. In this study, an economic comparison of 3 vaccination strategies (mass adolescent vaccination, mass infant vaccination and mass combined vaccination) was performed in Catalonia, Spain. Screening pregnant women for HBV infection in combination with these strategies was also evaluated. Epidemiological models to analyse patterns of HBV infection with and without vaccination and to calculate HBV-associated costs were designed. Comparison between strategies was done using cost-effectiveness analysis from the perspective of the healthcare system.

Epidemiological model results indicate that implementation of HBV vaccination could prevent as many as 104 778 new acute infections, and avoid up to 5239 chronic infections, 2096 cases of cirrhosis and 419 cases of hepatocarcinoma over a 20-year period in Catalonia. Cost-effectiveness analysis shows that mass adolescent vaccination is the most efficient strategy, with lower costs per avoided case than the other 2 strategies. When any of these strategies is complemented by screening for HBV in pregnant women, the number of avoided cases is always higher and the cost per avoided case decreases or remains unchanged.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Holliday S, Faulds D. Hepatitis B vaccine a pharmacoeconomic evaluation of its use in the prevention of hepatitis B virus infection. Pharmacoeconomics 1994; 5 (2): 1994

    Article  Google Scholar 

  2. Vyas GN, Blum HE. Hepatitis B virus infection-current Concepts of chronicity and immunity. West J Med 1984; 140: 754–62

    PubMed  CAS  Google Scholar 

  3. Sherlock S. Diseases of the liver alld biliary system, 8th ed. Oxford: Blackwell Scienlific Publications, 1989

  4. Centers for Disease Control. Update on hepatitis B prevention: recommendations of the immunization practices advisory committee. Ann Intern Med 1987: 107: 353–7

    Google Scholar 

  5. Sherlock S. Virus hepatitis B, A, non-A, non-B. J Hepatol 1989; 8: 254–8

    Article  PubMed  CAS  Google Scholar 

  6. Centers for Disease Control, Hepatitis B virus: a comprehensive strategy for eliminating transmission in the United States through universal childhood vaccination. MMWR Morb Mortal Wkly Rep 1991, 40 (RR13): 1–25

    Google Scholar 

  7. Bruguera M, Sánchez JM. Epidemiología de la hepatitis B en España. Med Clin (Barc) 1990: 95: 470–5

    CAS  Google Scholar 

  8. Kiire CF. Hepatitis B infection in sub-Saharan Africa: the African Regional Study Group. Vaccine 1990: 8 Suppl.: 107–12

    Article  Google Scholar 

  9. Salleras L, Bruguera M, Vidal J. et al. Prevalence of hepatitis B markers in the population of Catalonia (Spain): rationale for universal vaccination of adolescents. Eur J Epidemiol 1992: 8: 2982–90

    Article  Google Scholar 

  10. Sherlock S. Hepatitis B: the disease. Vaccine 1990: 8 Suppl.: 56–9

    Google Scholar 

  11. Brugucra M. ¿Cömo y a quién vacunar contra la hepatitis B en España?. J Med Clin (Barc) 1984: 82: 546–8

    Google Scholar 

  12. Bruguera M. La vacunaciön contra la hepatitis B: un objetivo prioritario. Jano 1989; 37: 61–4

    Google Scholar 

  13. Blumberg BS. International Conference on Prospects for Eradication of Hepatitis B Virus. Vaccine: 1990: 8 Suppl.: 586–92

    Google Scholar 

  14. André FE, Safary A. Summary of clinical findings on Engerix B, a genetically engineered yeast-derived hepatitis B vaccine. Postgrad Med J 1987: 63 Suppl. 2: 169–78

    Google Scholar 

  15. Postgrad Med J 1987: 63 Suppl. 2: 169–78

  16. De Jongh FE, Janssen HLA, De Man RA, et al. Survival and prognostic indication in hepatitis B surface antigen-positive cirrhosis. Gastroenterology 1992: 103: 1630–5

    PubMed  Google Scholar 

  17. Institulo Nacional de: Estadística. Encuesta de morbilidad hospitalaria 1990. Madrid: Instituto Nacional de Estadística, 1993

  18. Weinstein MC, Stason WB. Foundations of cost-effectiveness for health and medical practices. N Engl J Med 1977: 296: 716–2 1

    Article  PubMed  CAS  Google Scholar 

  19. Weinstein MC, Fineberg HV, Elstein AS, et al. Clinical decision analysis. Philadelphia: WB Saunders Company, 1980

    Google Scholar 

  20. Femández-Barboza R, Rivero D, Echeverria B, et al. Costobeneficio de la vacunaciön contra la hepatitis B en trabajadores de hospitales de Venezuela. Bol Oficina Sanit Panam 1991: 111: 16–23

    Google Scholar 

  21. Hayashi J, Nakashima K, Noguchi A, et al. Cost effectiveness of intradermal vs. subcutaneous hepatitis B vaccination for the mentally handicapped. J Infect 1991: 23; 39–45

    Article  PubMed  CAS  Google Scholar 

  22. Mauskopf JA, Bradley CJ, French MT. Benefit-cost analysis of hepatitis B vaccine program for occupationally exposed workers. J Occup Med 1991: 33: 691–8

    Article  PubMed  CAS  Google Scholar 

  23. Chongsuvivatwong V. A simplified financial cost-effectiveness anallysis of programs for prevention of Hepatitis B accidental inoculation among hospital personnel in Thailand. Southeast Asian J Trop Med Public Health 1989: 20: 189–93

    PubMed  CAS  Google Scholar 

  24. Thomas IL. Cost effectiveness of antenatal hepatitis B screening and vaccination of infants. Aust N Z J Obstet Gynaecol 1990: 30: 331–5

    Article  PubMed  CAS  Google Scholar 

  25. Caetano JA. Erradicacao da hepatite B em Portugal: um desafio ao alcance do Servico Nacional de Saude. Acta Med Port 1990; 3: 71–4

    PubMed  CAS  Google Scholar 

  26. Maynard JE, Kane MA, Hadler SC. Global control of hepatilis B through vaccination: role of hepatitis B vaccine in the: Expanded Programme on Immunization. Rev Infect Dis 1989: 11 Suppl. 3; S574–8

    Article  Google Scholar 

  27. Mulley AG, Silverstein MD, Dienstag JL. Indications for use of hepatitis B vaccine, based on cost–effectiveness analysis. N Engl J Med 1982: 307: 644–52

    Article  PubMed  CAS  Google Scholar 

  28. Krahn M, Detsky AS. Should Canada and the United States universally vaccinate infant against hepatitis B?. Med Decis Making 1993: 13: 4–20

    Article  PubMed  CAS  Google Scholar 

  29. Bloom LS, Hillman AL, Fendrick AM, et al. A reappraisal of hepatilis B vaccination strategy using cost–effectiveness analysis. Ann Intern Med 1993: 118: 298–306

    PubMed  CAS  Google Scholar 

  30. Fox JP, Elveback L, Stott W, et al. Herd immunity: basis and relevance to public heal th immunization practices. Am J Epidemiol 1971: 94: 178–89

    Google Scholar 

  31. Jonsson B, Horisberger B, Bruguera M, et al. Cost–benefit analysis of hepatitis B vaccination: a computerized decision model for Spain. Am J Technol Assess Health Care 1991: 7: 379–402

    Article  CAS  Google Scholar 

  32. Demicheli V, Jefferson TO. Cost–benefit analysis of the introduction of mass vaccination against hepatitis B in Italy. J Public Health Med 1992: 14: 367–75

    PubMed  CAS  Google Scholar 

  33. Ginsberg GM, Berger S, Shouval D. Cost–benifit analysis of a nationwide inoculation programme against hepatitis B in an area of intermediate endemicity. Bull World Health Organ 1992: 70: 757–67

    PubMed  CAS  Google Scholar 

  34. Ginsberg GM, Shouval O, Cost–benifit analysis of a nationwide inoculation programme against hepatitis B in an area of intermediate endemicity. J Epidemiol Community Health 1992: 46: 587–94

    Google Scholar 

  35. Hatziandreu EJ, Hatzakis A, Halziyannis S, et al. Cost–effectiveness of hepatitis B vaccine in Greece; a country of intermediate HBV endemicity. Am J Technol Assess Health Care: 1991; 7: 256–62

    Article  CAS  Google Scholar 

  36. Jefferson T, Demicheli V. Is vaccination against hepatitis B efficient? A review of world literature. Health Econ 1994: 3: 25–37

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Economics, University of La Rioja, Avenida de la Paz 1,4° D, 26004, Logroño, Spain

    Fernando Antoñanzas

  2. SOIKOS, SL (Centre of Health Economics and Social Policy), Barcelona, Spain

    Fernando Antoñanzas, Joan Rovira & Cristina Trinxet

  3. National Institute of Health, Zaragoza, Spain

    Roberto Garuz

  4. Department of Economics, Central University of Barcelona, Barcelona, Spain

    Joan Rovira

  5. Hospital San Millán, Logroño, Spain

    Francisco Antón

  6. Department of Health and Social Security, Barcelona, Spain

    Encarnación Navas & Luis Salleras

Authors
  1. Fernando Antoñanzas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Roberto Garuz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joan Rovira
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Francisco Antón
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Cristina Trinxet
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Encarnación Navas
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Luis Salleras
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Antoñanzas, F., Garuz, R., Rovira, J. et al. Cost-Effectiveness Analysis of Hepatitis B Vaccination Strategies in Catalonia, Spain. Pharmacoeconomics 7, 428–443 (1995). https://doi.org/10.2165/00019053-199507050-00007

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00019053-199507050-00007

Keywords

Search

Navigation