Abstract
Background
Socioeconomic improvements can reduce levels of endemic hepatitis A, but conversely increase the burden of disease. Routine childhood vaccination can rapidly control hepatitis A infection rates through the induction of herd immunity, although such programs can be costly.
Methods
We evaluated the healthcare benefits and cost-effectiveness of a routine childhood vaccination program against hepatitis A in Argentina, using a dynamic model that incorporated the changing epidemiology of infection and the impact of vaccine-induced herd immunity. Demographic, disease, and economic data from Argentina were used where available.
Results
At 95% coverage, the program would reduce the number of hepatitis A infections by 352 405 annually, avoiding 121 587 symptomatic cases and 428 deaths. Substantial healthcare benefits were also observed with vaccination coverage as low as 70%, which would prevent 295 826 infections. Economically, the program would save US$23 989 963 annually at 95% coverage, equivalent to US$3 429 per life-year gained. The program remained cost-saving in response to variation in factors, including disease-related costs, discount rate, herd immunity level, and rate of decrease of force of infection. The break-even cost per vaccine dose for the society was US$25 in the base-case, more than three times the current public cost of US$7 per dose.
Conclusions
Routine childhood vaccination against hepatitis A showed both health benefits and robust economic benefits in this analysis, supporting the recent decision of the Argentine government to implement such a program.
Similar content being viewed by others
References
World Health Organization. Department of Communicable Disease Surveillance and Response. Hepatitis A. WHO/CDS/CSR/EDC/2000.7. http://www.who.int/csr/disease/hepatitis/HepatitisA_whocdscsredc2000_7.pdf
JJ Berge DP Drennan RJ Jacobs A Jakins AS Meyerhoff W Stubblefield et al. (2000) ArticleTitleThe cost of hepatitis A infections in American adolescents and adults in 1997 Hepatology 31 469–73 Occurrence Handle10655272 Occurrence Handle10.1002/hep.510310229 Occurrence Handle1:STN:280:DC%2BD3c7it1enuw%3D%3D
Debbag R, Sarquis C, Brieschke Rodriguez T, Torrija C, Speranza A. Economic evaluation of hepatitis A vaccination in Argentine children after 2001 country economic crisis (abstract). In: Program and abstracts of the 11th Congress of the International Society for Infectious Diseases, Cancun, Mexico, March 4–7, 2004
R Tapia-Conyer JI Santos AM Cavalcanti E Urdaneta L Rivera A Manterola et al. (1999) ArticleTitleHepatitis A in Latin America: a changing epidemiologic pattern Am J Trop Med Hyg 61 825–9 Occurrence Handle10586919 Occurrence Handle1:STN:280:DC%2BD3c%2Flt1ajsA%3D%3D
YM Sohn HO Rho MS Park JH Park BY Choi M Ki et al. (2000) ArticleTitleThe changing epidemiology of hepatitis A in children and the consideration of active immunization in Korea Yonsei Med J 41 34–9 Occurrence Handle10731917 Occurrence Handle1:STN:280:DC%2BD3c7ps1CltA%3D%3D
InstitutionalAuthorNameWorld Health Organization (2000) ArticleTitleHepatitis A vaccines position paper Wkly Epidemiol Rec 5 38–44
AS Meyerhoff RJ Jacobs (2001) ArticleTitleTransmission of hepatitis A through household contact J Viral Hepat 8 454–8 Occurrence Handle11703577 Occurrence Handle10.1046/j.1365-2893.2001.00317.x Occurrence Handle1:STN:280:DC%2BD3Mnlt1Kluw%3D%3D
CJ Muecke C Beliveau E Rahme JC Soto TW Gyorkos (2004) ArticleTitleHepatitis A seroprevalence and risk factors among day-care educators Clin Invest Med 27 259–64 Occurrence Handle15559862
LV Venczel MM Desai PD Vertz B England YJ Hutin CN Shapiro et al. (2001) ArticleTitleThe role of child care in a community-wide outbreak of hepatitis A Pediatrics 108 E78 Occurrence Handle11694662 Occurrence Handle10.1542/peds.108.5.e78 Occurrence Handle1:STN:280:DC%2BD3MnksFGrtQ%3D%3D
JC Victor TY Surdina SZ Suleimenova MO Favorov BP Bell AS Monto (2006) ArticleTitlePerson-to-person transmission of Hepatitis A virus in an urban area of intermediate endemicity: implications for vaccination strategies Am J Epidemiol 163 204–10 Occurrence Handle16339053 Occurrence Handle10.1093/aje/kwj029 Occurrence Handle1:STN:280:DC%2BD28%2FjsFaltQ%3D%3D
F Averhoff CN Shapiro BP Bell I Hyams L Burd A Deladisma et al. (2001) ArticleTitleControl of hepatitis A through routine vaccination of children JAMA 286 2968–73 Occurrence Handle11743837 Occurrence Handle10.1001/jama.286.23.2968 Occurrence Handle1:STN:280:DC%2BD38%2FivFWktQ%3D%3D
V Demicheli D Tiberti (2003) ArticleTitleThe effectiveness and safety of hepatitis A vaccine: a systematic review Vaccine 21 2242–5 Occurrence Handle12744850 Occurrence Handle10.1016/S0264-410X(03)00135-X Occurrence Handle1:CAS:528:DC%2BD3sXjs1WmtLY%3D
A Dominguez L Salleras G Carmona J Batalla (2003) ArticleTitleEffectiveness of a mass hepatitis A vaccination program in preadolescents Vaccine 21 698–701 Occurrence Handle12531343 Occurrence Handle10.1016/S0264-410X(02)00583-2
PL Lopalco L Salleras S Barbuti C Germinario M Bruguera M Buti et al. (2000) ArticleTitleHepatitis A and B in children and adolescents—what can we learn from Puglia (Italy) and Catalonia (Spain)? Vaccine 19 470–4 Occurrence Handle11027810 Occurrence Handle10.1016/S0264-410X(00)00193-6 Occurrence Handle1:STN:280:DC%2BD3M%2FlslKruw%3D%3D
T Samandari BP Bell GL Armstrong (2004) ArticleTitleQuantifying the impact of hepatitis A immunization in the United States, 1995–2001 Vaccine 22 4342–50 Occurrence Handle15474727 Occurrence Handle10.1016/j.vaccine.2004.04.014
P Van Damme J Banatvala O Fay S Iwarson B McMahon K Van Herck et al. (2003) ArticleTitleHepatitis A booster vaccination: is there a need? Lancet 362 1065–71 Occurrence Handle14522539 Occurrence Handle10.1016/S0140-6736(03)14418-2 Occurrence Handle1:STN:280:DC%2BD3svmtFalsQ%3D%3D
E Vidor R Dumas V Porteret F Bailleux K Veitch (2004) ArticleTitleAventis Pasteur vaccines containing inactivated hepatitis A virus: a compilation of immunogenicity data Eur J Clin Microbiol Infect Dis 23 300–9 Occurrence Handle15007703 Occurrence Handle10.1007/s10096-003-1094-0 Occurrence Handle1:CAS:528:DC%2BD2cXjt1GmsLY%3D
C Zamir S Rishpon D Zamir A Leventhal N Rimon E Ben-Porath (2001) ArticleTitleControl of a community-wide outbreak of hepatitis A by mass vaccination with inactivated hepatitis A vaccine Eur J Clin Microbiol Infect Dis 20 185–7 Occurrence Handle11347668 Occurrence Handle10.1007/s100960100461 Occurrence Handle1:STN:280:DC%2BD3MrhsFyjug%3D%3D
R Dagan A Leventhal E Anis PE Slater Y Ashur D Shouval (2005) ArticleTitleIncidence of Hepatitis A in Israel following universal immunization of toddlers JAMA 294 202–10 Occurrence Handle16014594 Occurrence Handle10.1001/jama.294.2.202 Occurrence Handle1:CAS:528:DC%2BD2MXmtlSls7c%3D
JM Arnal O Frisas R Garuz F Antonanzas (1997) ArticleTitleCost effectiveness of hepatitis A virus immunisation in Spain Pharmacoeconomics 12 361–73 Occurrence Handle10170461 Occurrence Handle1:STN:280:DyaK2svltlOqsQ%3D%3D Occurrence Handle10.2165/00019053-199712030-00008
A Das (1999) ArticleTitleAn economic analysis of different strategies of immunization against hepatitis A virus in developed countries Hepatology 29 548–52 Occurrence Handle9918934 Occurrence Handle10.1002/hep.510290225 Occurrence Handle1:STN:280:DyaK1M7hvFChsg%3D%3D
V Demicheli E Carniglia S Fucci (2003) ArticleTitleThe use of hepatitis A vaccination in Italy: an economic evaluation Vaccine 21 2250–7 Occurrence Handle12744852 Occurrence Handle10.1016/S0264-410X(03)00136-1
GM Ginsberg PE Slater D Shouval (2001) ArticleTitleCost-benefit analysis of a nationwide infant immunization programme against hepatitis A in an area of intermediate endemicity J Hepatol 34 92–9 Occurrence Handle10.1016/S0168-8278(00)00007-6
RJ Jacobs DP Greenberg RS Koff S Saab AS Meyerhoff (2003) ArticleTitleRegional variation in the cost effectiveness of childhood hepatitis A immunization Pediatr Infect Dis J 22 904–14 Occurrence Handle14551492 Occurrence Handle10.1097/00006454-200303000-00005
RJ Jacobs HS Margolis PJ Coleman (2000) ArticleTitleThe cost-effectiveness of adolescent hepatitis A vaccination in states with the highest disease rates Arch Pediatr Adolesc Med 154 763–70 Occurrence Handle10922271 Occurrence Handle1:STN:280:DC%2BD3cvgvFGmsw%3D%3D
M Pechevis B Khoshnood L Buteau I Durand Y Piquard A Lafuma (2003) ArticleTitleCost-effectiveness of hepatitis A vaccine in prevention of secondary hepatitis A infection Vaccine 21 3556–64 Occurrence Handle12922083 Occurrence Handle10.1016/S0264-410X(03)00424-9
MJ Postma JM Bos P Beutels H Schilthuis JA van den Hoek (2004) ArticleTitlePharmaco-economic evaluation of targeted hepatitis A vaccInation for children of ethnic minorities in Amsterdam (The Netherlands) Vaccine 22 1862–7 Occurrence Handle15121296 Occurrence Handle10.1016/j.vaccine.2003.11.012 Occurrence Handle1:STN:280:DC%2BD2c3isValtQ%3D%3D
P Rosenthal (2003) ArticleTitleCost-effectiveness of hepatitis A vaccination in children, adolescents, and adults Hepatology 37 44–51 Occurrence Handle12500187 Occurrence Handle10.1053/jhep.2003.50016
S Saab P Martin HF Yee SuffixJr (2000) ArticleTitleA simple cost-decision analysis model comparing two strategies for hepatitis A vaccination Am J Med 109 241–4 Occurrence Handle10974188 Occurrence Handle10.1016/S0002-9343(00)00469-1 Occurrence Handle1:STN:280:DC%2BD3cvnsFequg%3D%3D
S Soogarun V Wiwanitkit (2002) ArticleTitleVaccinating Thai adolescents against hepatitis A: is it cost-effective? Southeast Asian J Trop Med Public Health 33 IssueIDSuppl 3 145–8 Occurrence Handle12971496
Argentine Ministry of Health. National vaccine calendar. 2005. Available at: http://www.msal.gov.ar/htm/site/vacuna._cal2.asp
Argentine National Institute of Statistics and Censuses (INDEC). Available at: http://www.indec.mecon.ar/
Debbag R, Sarquis C, Bes D, Fernandez Torroija M, Ciocca M, Speranza A. 10 years experience in fulminant hepatic failure due to hepatitis A. Costs and evolution (abstract). In: Program and abstracts of the 11th Congress of the International Society for Infectious Diseases, Cancun, Mexico, March 4–7, 2004
InstitutionalAuthorNamePrevention of hepatitis A through active or passive immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP) (1999) MMWR Recomm Rep 48 IssueIDRR-12 1–37
M Ciocca (2000) ArticleTitleClinical course and consequences of hepatitis A infection Vaccine 18 IssueIDSuppl 1 S71–4 Occurrence Handle10683554 Occurrence Handle10.1016/S0264-410X(99)00470-3
BibInstitutionalEditorNameCenters for Disease Control and Prevention W Atkinson J Hamborsky L McIntyre S Wolfe (Eds) (2006) Epidemiology and prevention of vaccine-preventable diseases EditionNumber9th ed Public Health Foundation Washington DC
InstitutionalAuthorNameACIP (2006) ArticleTitlePrevention of Hepatitis A through active or passive immunization MMWR Recommendations and Reports 55 RR-7
World Health Organization. Life tables. Available at: http://www.who.int/countries/en/
GL Armstrong BP Bell (2002) ArticleTitleHepatitis A virus infections in the United States: model-based estimates and implications for childhood immunization Pediatrics 109 839–45 Occurrence Handle11986444 Occurrence Handle10.1542/peds.109.5.839
Lopez E, Debbag R, Coudeville L, Baron-Papillon F, Armoni J. Cost-effectiveness of vaccination against hepatitis A in children: the case of Argentina (abstract). In: Program and abstracts of the 4th World Congress of the World Society for Pediatric Infectious Diseases, Warsaw, Poland, September 1–4, 2005
R Anderson R May (1991) Infectious diseases of humans: dynamics and control Oxford University Press Oxford
MR Gold JE Siegel LB Russel et al. (1996) Cost-effectiveness in health and medicine Oxford University Press Oxford
DB Rein AE Fiore BP Bell (2006) ArticleTitleWhat's next for the hepatitis A vaccine? Lancet 367 546–8 Occurrence Handle16488780 Occurrence Handle10.1016/S0140-6736(06)68196-8
MT Valenzuela RJ Jacobs O Arteaga MS Navarrete AS Meyerhoff BL Innis (2005) ArticleTitleCost-effectiveness of universal childhood hepatitis A vaccination in Chile Vaccine 23 4110–9 Occurrence Handle15964479 Occurrence Handle10.1016/j.vaccine.2005.03.021
M Brisson WJ Edmunds (2003) ArticleTitleEconomic evaluation of vaccination programs: the impact of herd-immunity Med Decis Making 23 76–82 Occurrence Handle12583457 Occurrence Handle10.1177/0272989X02239651 Occurrence Handle1:STN:280:DC%2BD3s%2Fnt1Cmug%3D%3D
RJ Jacobs AS Meyerhoff (2001) ArticleTitleComparative cost effectiveness of varicella, hepatitis A, and pneumococcal conjugate vaccines Prev Med 33 639–45 Occurrence Handle11716661 Occurrence Handle10.1006/pmed.2001.0938 Occurrence Handle1:STN:280:DC%2BD3MnntFOksA%3D%3D
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Lopez, E., Debbag, R., Coudeville, L. et al. The cost-effectiveness of universal vaccination of children against hepatitis A in Argentina: results of a dynamic health–economic analysis. J Gastroenterol 42, 152–160 (2007). https://doi.org/10.1007/s00535-006-1984-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00535-006-1984-x