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Regional variation in the cost effectiveness of childhood hepatitis A immunization


The Pediatric Infectious Disease Journal: October 2003 - Volume 22 - Issue 10 - p 904-914
doi: 10.1097/01.inf.0000091295.53969.6a
Original Studies

Background. Routine childhood hepatitis A immunization is recommended in regions with incidence rates twice the national average, but it may be cost-effective in a wider geographic area.

Objective. To evaluate the costs and benefits of potential hepatitis A immunization of healthy US children in regions with varying hepatitis A incidences.

Methods. We considered vaccination of the 2000 US birth cohort in states defined by historic hepatitis A incidence rates. Infections among potential vaccinees and their personal contacts were predicted from age 2 through 85 years. Net vaccination costs were estimated from health system and societal perspectives and were compared with life-years saved and quality-adjusted life years (QALYs) gained using a 3% discount rate.

Results. Nationally vaccination would prevent >75 000 cases of overt hepatitis A disease. Approximately two-thirds of health benefits would accrue to personal contacts rather than to vaccinees themselves. In states with incidence rates of ≥200%, 100 to 199%, 50 to 99% and <50% the national average, societal costs per QALY gained would be <$0, <$0, $13 800 and $63 000, respectively. Nationally vaccination would cost $9100 per QALY gained from the perspective of the health system and $1400 per QALY gained from society’s perspective. Results are most sensitive to vaccination costs and rates of disease transmission through personal contact.

Conclusion. Childhood hepatitis A vaccination is most cost-effective in areas with the highest incidence rates but would also meet accepted standards of economic efficiency in most of the US. A national immunization policy would prevent substantial morbidity and mortality, with cost effectiveness similar to that of other childhood immunizations.

From Capitol Outcomes Research, Inc., Alexandria, VA (RJJ, ASM); the Department of Pediatrics, University of Pittsburgh School of Medicine, and Division of Allergy, Immunology and Infectious Diseases, Children’s Hospital of Pittsburgh, Pittsburgh, PA (DPG); the Division of Gastroenterology, University of Massachusetts Medical School, Worcester, MA (RSK); and the Departments of Medicine and Surgery, University of California Los Angeles, Los Angeles, CA (SS).

Accepted for publication July 16, 2003.

*Current address: Roche Laboratories, Nutley, NJ.

Address for reprints: R. Jake Jacobs, Research Director, Capitol Outcomes Research, Inc., 6188 Old Franconia Road, Alexandria, VA 22310. Fax 703-922-1853; E-mail

© 2003 Lippincott Williams & Wilkins, Inc.