Cost-effectiveness analysis of catch-up hepatitis A vaccination among unvaccinated/partially-vaccinated children

Details

• Alternative Title:
  Vaccine
• Personal Author:
  Hankin-Wei, Abigail ; Rein, David B. ; Hernandez-Romieu, Alfonso ; Kennedy, Mallory J. ; Bulkow, Lisa ; Rosenberg, Eli ; Trigg, Monica ; Nelson, Noele P.
• Description:
  Background
  
  Since 2006, the US Centers for Disease Control and Prevention has recommended hepatitis A (HepA) vaccination routinely for children aged 12–23 months to prevent hepatitis A virus (HAV) infection. However, a substantial proportion of US children are unvaccinated and susceptible to infection. We present results of economic modeling to assess whether a one-time catch-up HepA vaccination recommendation would be cost-effective.
  
  Methods
  
  We developed a Markov model of HAV infection that followed a single cohort from birth through death (birth to age 95 years). The model compared the health and economic outcomes from catch-up vaccination interventions for children at target ages from two through 17 years vs. outcomes resulting from maintaining the current recommendation of routine vaccination at age one year with no catch-up intervention.
  
  Results
  
  Over the lifetime of the cohort, catch-up vaccination would reduce the total number of infections relative to the baseline by 741 while increasing doses of vaccine by 556,989. Catch-up vaccination would increase net costs by $10.2 million, or $2.38 per person. The incremental cost of HepA vaccine catch-up intervention at age 10 years, the midpoint of the ages modeled, was $452,239 per QALY gained. Across age-cohorts, the cost-effectiveness of catch-up vaccination is most favorable at age 12 years, resulting in an Incremental Cost-Effectiveness Ratio of $189,000 per QALY gained.
  
  Conclusions
  
  Given the low baseline of HAV disease incidence achieved by current vaccination recommendations, our economic model suggests that a catch-up vaccination recommendation would be less cost-effective than many other vaccine interventions, and that HepA catch-up vaccination would become cost effective at a threshold of $50,000 per QALY only when incidence of HAV rises about 5.0 cases per 100,000 population.
  
  
• Subjects:
  Adolescent Child Child, Preschool Cost-Benefit Analysis Hepatitis A Hepatitis A Vaccines Humans Immunization, Secondary Models, Economic Quality-Adjusted Life Years Vaccination

  More +
• Keywords:
  Economic Modeling Vaccine Recommendation
• Source:
  Vaccine. 34(35):4243-4249
• Pubmed ID:
  27317459
• Pubmed Central ID:
  PMC5582969
• Document Type:
  Journal Article
• Funding:
  CC999999/Intramural CDC HHSUnited States/ ; U38 PS004646/PS/NCHHSTP CDC HHSUnited States/
• Volume:
  34
• Issue:
  35
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:87230ecf2a7124af8341f9ae14d76c31a95592fa903efd455c25cfd0ce97bd67
• Download URL:
  https://stacks.cdc.gov/view/cdc/47999/cdc_47999_DS1.pdf
• File Type:
  [PDF - 249.52 KB ]