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Cost-Effectiveness Analyses of Hepatitis A Vaccine

A Systematic Review to Explore the Effect of Methodological Quality on the Economic Attractiveness of Vaccination Strategies

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Abstract

Cost-effectiveness/cost-utility studies of hepatitis A vaccine were identified via a series of literature searches (MEDLINE, EMBASE, HSTAR and SSCI). Citations and full-text articles were reviewed independently by two reviewers. Reference searching, author searches and expert consultation ensured literature saturation. Incremental cost-effectiveness ratios (ICERs) were abstracted for base-case analyses, converted to $US, year 2005 values, and categorised to reflect various levels of cost effectiveness. Quality of reporting, methodological issues and key modelling issues were assessed using frameworks published in the literature.

Thirty-one cost-effectiveness studies (including 12 cost-utility analyses) were included from full-text article review (n = 58) and citation screening (n = 570). These studies evaluated universal mass vaccination (n = 14), targeted vaccination (n = 17) and vaccination of susceptibles (i.e. individuals initially screened for antibody and, if susceptible, vaccinated) [n = 13]. For universal vaccination, 50% of the ICERs were <$US20 000 per QALY or life-year gained. Analyses evaluating vaccination in children, particularly in high incidence areas, produced the most attractive ICERs. For targeted vaccination, cost effectiveness was highly dependent on the risk of infection.

Incidence, vaccine cost and discount rate were the most influential parameters in sensitivity analyses. Overall, analyses that evaluated the combined hepatitis A/hepatitis B vaccine, adjusted incidence for under-reporting, included societal costs and that came from studies of higher methodological quality tended to have more attractive cost-effectiveness ratios. Methodological quality varied across studies. Major methodological flaws included inappropriate model type, comparator, incidence estimate and inclusion/exclusion of costs.

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Acknowledgements

This study was part of a research grant to C. Bauch funded by the Canadian Institutes of Health Research Industry-Partnered Operating Grant and GlaxoSmithKline, Canada. A. Tricco, A. John-Baptiste and G. Woo have held research contracts with GlaxoSmithKline, Canada. A. Anonychuk is currently employed by GlaxoSmithKline, Canada and B. Pham was an employee at the time of this project. M. Krahn is sponsored, in part, by an Investigator Award from CIHR and the F. Norman Hughes Chair in Pharmacoeconomics, Faculty of Pharmacy, University of Toronto. A. Tricco is sponsored, in part, by a CIHR Doctoral Research Award.

We would like to thank Carmen Ng for her assistance with the preparation of the manuscript.

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Authors and Affiliations

  1. Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada

    Andrea M. Anonychuk, Gloria Woo &  Murray Krahn

  2. Statistics and Epidemiology, GlaxoSmithKline Canada, Mississauga, Ontario, Canada

    Andrea M. Anonychuk

  3. Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada

    Andrea M. Anonychuk, Ba’ Pham, Ava John-Baptiste, Gloria Woo &  Murray Krahn

  4. Chalmers Research Group, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada

    Andrea C. Tricco & Ba’ Pham

  5. Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada

    Andrea C. Tricco

  6. Department of Mathematics and Statistics, University of Guelph, Guelph, Ontario, Canada

    Chris T. Bauch

  7. Department of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

    Ba’ Pham, Ava John-Baptiste &  Murray Krahn

  8. Institut National de Santé Publique du Québec, Québec City, Québec, Canada

    Vladimir Gilca & Bernard Duval

  9. Centre Hospitalier Universitaire de Québec (CHUQ) Research Centre, Québec City, Québec, Canada

    Vladimir Gilca & Bernard Duval

  10. University Health Network, Toronto, Ontario, Canada

    Ava John-Baptiste &  Murray Krahn

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  1. Andrea M. Anonychuk
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  5. Vladimir Gilca
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  9. Murray Krahn
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Correspondence to Murray Krahn.

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Anonychuk, A.M., Tricco, A.C., Bauch, C.T. et al. Cost-Effectiveness Analyses of Hepatitis A Vaccine. Pharmacoeconomics 26, 17–32 (2008). https://doi.org/10.2165/00019053-200826010-00003

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