Abstract
Objective: To evaluate, in economic terms, active vaccination campaigns against hepatitis A in comparison with the use of nonspecific immune globulin for the prevention of the disease among daycare centre employees in Israel.
Setting: Hypothetical analysis of the costs and benefits related to vaccination campaigns of workers currently employed in daycare centres in Israel.
Methods: A cost-benefit analysis was performed, comparing mass and selective active vaccination strategies for the daycare centre working force. Direct and indirect costs of diagnosis, treatment and immunisation as well as productivity loss were considered. A Markov-based model was developed using data from previous epidemiological studies and literature.
Results: The benefit-to-cost ratios of selective and mass active vaccination strategies were 1.50 [net present value (NPV) $US606 396] and 0.04 (NPV-$US2.36 million), respectively (2000 values).
Conclusion: Under these study assumptions, the practice of administering hepatitis A active vaccine to serologically proven non-immune daycare centre workers has a cost-benefit justification, and should be widely considered in countries with a similar hepatitis A epidemiology to that in this study.
Similar content being viewed by others
References
Gregorio GV, Mieli-Vergani G, Mowat AP. Viral hepatitis. Arch Dis Child 1994; 70 (4): 343–8
Centers for Disease Control. Community-wide outbreaks of hepatitis A. Hepatitis surveillance report no. 51. Atlanta (GA): CDC, 1987: 6–8
Koff RS. Clinical manifestations and diagnosis of hepatitis A virus infection. Vaccine 1992; 10 Suppl. 1: S15–7
Monthly epidemiologic record. Jerusalem: Department of Epidemiology — Israeli Ministry of Health, 1995 May-Dec
Green MS, Tsur S, Slepon R. Sociodemographic factors and the declining prevalence of anti-hepatitis A antibodies in young adults in Israel: implications for the new hepatitis A vaccines. Int J Epidemiol 1992; 21 (1): 136–41
Karetnyi YV, Mendelson E, Shlyakhov E, et al. Prevalence of antibodies against hepatitis A virus among new immigrants in Israel. J Med Virol 1995; 46 (1): 61–5
Hadler SC, McFarland L. Hepatitis in day care centres: epidemiology and prevention. Rev Infect Dis 1986; 8 (4): 548–57
Reves RR, Pickering LK. Infections in child day care centres as they relate to internal medicine. Annu Rev Med 1990; 41: 383–91
Lednar WM, Lemon SM, Kirkpatrick JW, et al. Frequency of illness associated with epidemic hepatitis A virus infection in adults. Am J Epidemiol 1985; 122: 226–33
Jacques P, Moens G, Van Damme P, et al. Increased risk for hepatitis A among female day nursery workers in Belgium. Occup Med 1994; 44: 259–61
Lerman Y, Chodik G, Aloni H, et al. Occupations at increased risk of hepatitis A: a 2-year nationwide historical prospective study. Am J Epidemiol 1999; 150 (3): 312–20
Thomson JA, Kennedy R, Thompson SC. Hepatitis A vaccination of child care workers in Victoria: are recommendations being implemented? Aust N Z J Public Health 1998; 22 (7): 832–4
Labour Force Surveys 1993. Jerusalem: Central Bureau of Statistics, 1995
Wiens B, Bohidar N, Pigeon J, et al. Duration of protection from clinical hepatitis A disease after vaccination with VAQTA. J Med Virol 1996; 49: 235–41
Lerman Y, Chodick G, Aloni H, et al. Is the health ministry official data valid? Hepatitis A as an example [in Hebrew]. Harefuha 1999; 136: 441–5
Peled T, Lerman Y, Chodik G, et al. Sero prevalence of hepatitis A antibodies among day-care center workers. EPICOH, 14th International Conference on Epidemiology in Occupational Health; 1999 Oct 10–14; Herzlia
Glikson M, Galun E, Oren R, et al. Relapsing hepatitis A: review of 14 cases and literature survey. Medicine 1992; 71: 14–23
Plans Rubio P. Critical value of prevalence for vaccination programmes: the case of hepatitis A vaccination in Spain. Vaccine 1997; 15 (12–13): 1445–50
Van Damme P, Thoelen S, Cramm M, et al. Inactivated hepatitis A vaccine: reactogenicity, immunogenicity, and long-term antibody persistence. J Med Virol 1994; 44: 446–51
Polesky HF, Hanson MR. Comparison of viral hepatitis marker test methods based on AABB-CAP survey data. Am J Clin Pathol 1981; 76 (4 Suppl.): 521–4
Ginsberg GM, Slater PE, Shouval D. Cost-benefit analysis of a nationwide infant immunization program against hepatitis A in an area of intermediate endemicity. J Hepatol. In press
Jefferson TO, Behrens RH, Demicheli V. Should British soldiers be vaccinated against hepatitis A? An economic analysis. Vaccine 1994; 12 (15): 1379–83
Behrens RH, Roberts JA. Is travel prophylaxis worth while? Economic appraisal of prophylactic measures against malaria, hepatitis A, and typhoid in travelers. BMJ 1994 Oct 8; 309 (6959): 918–22
Arcari C, Shapiro C, Mast E, et al. An economic analysis of the use of hepatitis A vaccine to control community epidemics [abstract no. 277]. Clin Infect Dis 1996; 23: 911
Smith S, Weber S, Wiblin T, et al. Cost-effectiveness of hepatitis A vaccination in healthcare workers. Infect Control Hosp Epidemiol 1997; 18 (10): 688–91
CDC vaccine price list [online]. Available from: URL: http://www.cdc.gov/nip/vfc/pricelist.pdf [Accessed 1999 Oct 26]
Kark JD, Camhy NA, Shany SB. Reduction in hepatitis A antibody prevalence among young adults in Israel. Public Health Rev 1992-93; 20 (1–2): 31–40
Vernon AA, Schable C, Francis D. A large outbreak of hepatitis A in a day-care center. Am J Epidemiol 1982; 115: 325–31
Johannesson M, Jonsson B. Economic evaluation in health care: is there a role for cost-benefit analysis? Health Policy 1991; 17 (1): 1–23
Acknowledgements
The authors wish to thank Dr Andrea K. Biddle, Dr Ya-Chen Tina Shin, Mrs Elinor C.G. Chumney and Mr David Harrison from the School of Public Health, University of North Carolina at Chapel Hill, North Carolina, USA, for their most valuable assistance; Dr Gary M. Ginsberg for supplying most valuable data; and the Fulbright US-Israel Mutual Educational Fund for its financial support.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Chodick, G., Lerman, Y., Peled, T. et al. Cost-Benefit Analysis of Active Vaccination Campaigns Against Hepatitis A Among Daycare Centre Personnel in Israel. Pharmacoeconomics 19, 281–291 (2001). https://doi.org/10.2165/00019053-200119030-00006
Published:
Issue Date:
DOI: https://doi.org/10.2165/00019053-200119030-00006