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de Souza CL, Salgado TDA, Sardeiro TL, Galdino H, Itria A, Tipple AFV. Post-vaccination anti-HBs testing among healthcare workers: More economical than post-exposure management for Hepatitis B. Rev Lat Am Enfermagem 2020; 28:e3278. [PMID: 32578749 PMCID: PMC7304982 DOI: 10.1590/1518-8345.3534.3278] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 03/03/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to compare the direct cost, from the perspective of the Unified Health System, of assessing the post-vaccination serological status with post-exposure management for hepatitis B among health care workers exposed to biological material. METHOD cross-sectional study and cost-related, based on accident data recorded in the System of Information on Disease Notification between 2006 and 2016, where three post-exposure and one pre-exposure management scenarios were evaluated: A) accidents among vaccinated workers with positive and negative serological status tests for hepatitis B, exposed to known and unknown source-person; B) handling unvaccinated workers exposed to a known and unknown source-person; C) managing vaccinated workers and unknown serological status for hepatitis B and D) cost of the pre-exposure post-vaccination test. Accidents were assessed and the direct cost was calculated using the decision tree model. RESULTS scenarios where workers did not have protective titles after vaccination or were unaware of the serological status and were exposed to a positive or unknown source-person for hepatitis B. CONCLUSION the direct cost of hepatitis B prophylaxis, including confirmation of serological status after vaccination would be more economical for the health system.
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Affiliation(s)
- Camila Lucas de Souza
- Secretaria Municipal de Saúde de Goiânia, Escola Municipal de Saúde
Pública de Goiânia, Goiânia, GO, Brazil
| | | | - Tatiana Luciano Sardeiro
- Secretaria Municipal de Saúde de Goiânia, Centro de Referência em
Saúde do Trabalhador de Goiânia, Goiânia, GO, Brazil
| | - Hélio Galdino
- Universidade Federal de Goiás, Faculdade de Enfermagem, Goiânia, GO,
Brazil
| | - Alexander Itria
- Universidade Federal de Goiás, Instituto de Patologia Tropical em
Saúde Pública, Goiânia, GO, Brazil
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Olivera I, Grau C, Dibarboure H, Torres JP, Mieres G, Lazarov L, Alvarez FP, Yescas JGL. Valuing the cost of improving Chilean primary vaccination: a cost minimization analysis of a hexavalent vaccine. BMC Health Serv Res 2020; 20:295. [PMID: 32272920 PMCID: PMC7147015 DOI: 10.1186/s12913-020-05115-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 03/17/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The phased withdrawal of oral polio vaccine (OPV) and the introduction of inactivated poliovirus vaccine (IPV) is central to the polio 'end-game' strategy. METHODS We analyzed the cost implications in Chile of a switch from the vaccination scheme consisting of a pentavalent vaccine with whole-cell pertussis component (wP) plus IPV/OPV vaccines to a scheme with a hexavalent vaccine with acellular pertussis component (aP) and IPV (Hexaxim®) from a societal perspective. Cost data were collected from a variety of sources including national estimates and previous vaccine studies. All costs were expressed in 2017 prices (US$ 1.00 = $Ch 666.26). RESULTS The overall costs associated with the vaccination scheme (4 doses of pentavalent vaccine plus 1 dose IPV and 3 doses OPV) from a societal perspective was estimated to be US$ 12.70 million, of which US$ 8.84 million were associated with the management of adverse events related to wP. In comparison, the cost associated with the 4-dose scheme with a hexavalent vaccine (based upon the PAHO reference price) was US$ 19.76 million. The cost of switching to the hexavalent vaccine would be an additional US$ 6.45 million. Overall, depending on the scenario, the costs of switching to the hexavalent scheme would range from an additional US$ 2.62 million to US$ 6.45 million compared with the current vaccination scheme. CONCLUSIONS The switch to the hexavalent vaccine schedule in Chile would lead to additional acquisition costs, which would be partially offset by improved logistics, and a reduction in adverse events associated with the current vaccines.
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Affiliation(s)
- Ignacio Olivera
- Centro de Investigaciones Económicas, CINVE, Salud, Montevideo, Uruguay
| | - Carlos Grau
- Centro de Investigaciones Económicas, CINVE, Salud, Montevideo, Uruguay
| | | | - Juan Pablo Torres
- Chile Departamento de Pediatría y Cirugía Infantil Oriente, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Gustavo Mieres
- Centro de Investigaciones Económicas, CINVE, Salud, Montevideo, Uruguay
| | - Luis Lazarov
- Centro de Investigaciones Económicas, CINVE, Salud, Montevideo, Uruguay
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Rajamoorthy Y, Radam A, Taib NM, Rahim KA, Munusamy S, Wagner AL, Mudatsir M, Bazrbachi A, Harapan H. Willingness to pay for hepatitis B vaccination in Selangor, Malaysia: A cross-sectional household survey. PLoS One 2019; 14:e0215125. [PMID: 30964934 PMCID: PMC6456223 DOI: 10.1371/journal.pone.0215125] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 03/28/2019] [Indexed: 12/17/2022] Open
Abstract
Background In Malaysia, one million individuals are estimated to be infected with the hepatitis B virus. A vaccine for infants has been compulsory since 1989, whereas those born before 1989 need to spend their own money to be vaccinated in private clinics or hospitals. The aim of this study was to investigate and ascertain the determinants of willingness to pay (WTP) for adult hepatitis B vaccine in Selangor, Malaysia. Methods In 2016, 728 households were selected through a stratified, two stage cluster sample and interviewed. Willingness to pay for hepatitis B vaccine was estimated using the Contingent Valuation Method, and factors affecting WTP were modelled with logit regression. Results We found that 273 (37.5%) of the households were willing to pay for hepatitis B vaccination. The mean and median of WTP was estimated at Ringgit Malaysia (RM)303 (approximately US$73) for the three dose series. The estimated WTP was significantly greater in those with higher levels of education, among Malays and Chinese (compared to others, predominantly Indians), and for those with greater perceived susceptibility to hepatitis B virus infection. Other factors–perceived severity, barriers, benefits and cues to action–were not significantly associated with WTP for adult hepatitis B vaccination. Conclusion Additional resources are needed to cover the households that are not willing to pay for hepatitis B vaccination. More awareness (particularly in regards to hepatitis B virus susceptibility) could change the national perception towards self-paid hepatitis B virus vaccination and increase hepatitis B vaccine coverage.
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Affiliation(s)
- Yogambigai Rajamoorthy
- Department of Economics, Faculty of Accountancy and Management, Universiti Tunku Abdul Rahman, Selangor, Malaysia
- Department of Economics, Faculty of Economics and Management, Universiti Putra Malaysia, Selangor, Malaysia
- * E-mail: (YR); (MM); (HH)
| | - Alias Radam
- Department of Economics, Faculty of Economics and Management, Universiti Putra Malaysia, Selangor, Malaysia
| | - Niazlin Mohd Taib
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Khalid Ab Rahim
- Department of Economics, Faculty of Economics and Management, Universiti Putra Malaysia, Selangor, Malaysia
| | - Subramaniam Munusamy
- Department of Economics, Faculty of Economics and Management, Universiti Putra Malaysia, Selangor, Malaysia
- Centre for Language and Foundation Studies, Manipal International University, Negeri Sembilan, Malaysia
| | - Abram Luther Wagner
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Mudatsir Mudatsir
- Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- * E-mail: (YR); (MM); (HH)
| | - Abdullatif Bazrbachi
- Department of Economics, Faculty of Economics and Management, Universiti Putra Malaysia, Selangor, Malaysia
| | - Harapan Harapan
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- School of Biomedical Sciences, University of Western Australia, Nedlands, Western Australia, Australia
- * E-mail: (YR); (MM); (HH)
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Rajamoorthy Y, Radam A, Taib NM, Rahim KA, Wagner AL, Mudatsir M, Munusamy S, Harapan H. The relationship between perceptions and self-paid hepatitis B vaccination: A structural equation modeling approach. PLoS One 2018; 13:e0208402. [PMID: 30521602 PMCID: PMC6283584 DOI: 10.1371/journal.pone.0208402] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 11/15/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Malaysia has a comprehensive, publicly-funded immunization program for hepatitis B (HepB) among infants, but adults must pay for the vaccine. The number of HepB carriers among adults is expected to increase in the future; therefore, we examined the impact of five constructs (cues to action, perceived barriers, perceived benefit, perceived severity, and perceived susceptibility) on adults' willingness to pay (WTP) for HepB vaccine; secondarily, we examined the association between perceived barriers and perceived benefits. METHODS Adults were selected through a stratified, two-stage cluster community sample in Selangor, Malaysia. The reliability, convergent validity, and discriminant validity of the measurement model were assessed before implementing a partial least squares structural equation model (PLS-SEM) to evaluate the significance of the structural paths. RESULTS A total of 728 participants were enrolled. The five constructs all showed adequate internal reliability, convergent validity, and discriminant validity. There was a significant, positive relationship to WTP from constructs (perceived barriers [Path coefficient (β) = 0.082, P = 0.036], perceived susceptibility [β = 0.214, P<0.001], and cues to action [β = 0.166, P<0.001]), and the model all together accounted for 8.8% of the variation in WTP. There was a significant, negative relationship between perceived barriers and perceived benefit [β = -0.261, P<0.001], which accounted for 6.8% of variation in perceived benefit. CONCLUSIONS Policy and programs should be targeted that can modify individuals' thoughts about disease risk, their obstacles in obtaining the preventive action, and their readiness to obtain a vaccine. Such programs include educational materials about disease risk and clinic visits that can pair HepB screening and vaccination.
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Affiliation(s)
- Yogambigai Rajamoorthy
- Department of Economics, Faculty of Accountancy and Management, Universiti Tunku Abdul Rahman, Kajang, Selangor, Malaysia
- Department of Economics, Faculty of Economics and Management, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Alias Radam
- Department of Economics, Faculty of Economics and Management, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Niazlin Mohd Taib
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Khalid Ab Rahim
- Department of Economics, Faculty of Economics and Management, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Abram Luther Wagner
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Mudatsir Mudatsir
- Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia
- Department of Microbiology, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia
| | - Subramaniam Munusamy
- Department of Economics, Faculty of Economics and Management, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- School of Management and Business, Manipal International University, Nilai, Negeri Sembilan, Malaysia
| | - Harapan Harapan
- Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia
- Tropical Disease Centre, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia
- School of Biomedical Sciences, University of Western Australia, Nedlands, Western Australia, Australia
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Hagstam P, Gröön P. [Unfortunate decision on hepatitis B vaccination]. Lakartidningen 2017; 114:EX9F. [PMID: 29292969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Petit D, Tevi-Benissan C, Woodring J, Hennessey K, Kahn AL. Countries' interest in a hepatitis B vaccine licensed for the controlled temperature chain; survey results from African and Western Pacific regions. Vaccine 2017; 35:6866-6871. [PMID: 29132994 PMCID: PMC5722051 DOI: 10.1016/j.vaccine.2017.10.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/24/2017] [Accepted: 10/12/2017] [Indexed: 10/28/2022]
Abstract
Chronic hepatitis B infection can be prevented by hepatitis B vaccine birth dose (hepB-BD) given within 24 h after birth, followed by two hepatitis B vaccinations within the first year of life. Yet nearly half of World Health Organization (WHO) Member States do not provide a hepB-BD. Barriers are primarily attributed to vaccine storage and transportation, as well as high rates of home births. Delivering the vaccine outside the cold chain could potentially increase coverage. To do this, WHO recommends vaccines be licensed for use in a "controlled temperature chain" (CTC), which requires a given product to tolerate temperature excursions up to at least 40 °C for a minimum of three days. To date, no hepB vaccine is labelled for CTC. To inform dialogue with manufacturers, WHO conducted a survey among countries in the African and Western Pacific Regions (AFR and WPR) to assess demand for a hepatitis B product licensed for use in a CTC. Twenty-five (44%) countries responded, with 8 of 11 (73%) from the WPR and 17 of 46 (37%) from the AFR. Of these responding countries, 5 in AFR and all 8 in WPR have introduced universal hepB-BD. Seventy-two percent indicated that CTC would facilitate the provision of hepB-BD. While no overall difference in responses was detected between countries either providing or not providing hepB-BD, countries that already introduced hepB-BD but had low hepB-BD coverage were particularly interested in CTC. Irrespective of hepB-BD policy, responding countries suggested that a CTC-licenced product would be beneficial, though the price of such a vaccine would influence procurement decisions. This survey was beneficial to inform the CTC agenda. However, countries' lack of experience with HepB-BD as well as with CTC and the fact that countries were commenting on a product that is not yet on the market should be acknowledged.
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Affiliation(s)
- Dörte Petit
- World Health Organization, Expanded Programme on Immunization, Geneva, Switzerland.
| | - Carole Tevi-Benissan
- World Health Organization, Regional Office for Africa, Brazzaville, People's Republic of Congo
| | - Joseph Woodring
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Karen Hennessey
- World Health Organization, Expanded Programme on Immunization, Geneva, Switzerland
| | - Anna-Lea Kahn
- World Health Organization, Expanded Programme on Immunization, Geneva, Switzerland
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Lee D, Park SM. Cost-Effectiveness Analysis of Hepatitis B Vaccination Strategies to Prevent Perinatal Transmission in North Korea: Selective Vaccination vs. Universal Vaccination. PLoS One 2016; 11:e0165879. [PMID: 27802340 PMCID: PMC5089722 DOI: 10.1371/journal.pone.0165879] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 10/19/2016] [Indexed: 11/23/2022] Open
Abstract
Background To tackle the high prevalence of Hepatitis B virus (HBV) infection in North Korea, it is essential that birth doses of HBV vaccines should be administered within 24 hours of birth. As the country fails to provide a Timely Birth Dose (TBD) of HBV vaccine, the efforts of reducing the high prevalence of HBV have been significantly hampered. Methods To examine the cost-effectiveness of vaccination strategies to prevent perinatal transmission of HBV in North Korea, we established a decision tree with a Markov model consisting of selective, universal, and the country’s current vaccination program against HBV. The cost-effectiveness analysis was performed from societal and payer’s perspectives and evaluated by Disability Adjusted Life Year (DALY). Results The results suggest that introducing the universal vaccination would prevent 1,866 cases of perinatal infections per 100,000 of the birth cohort of 2013. Furthermore, 900 cases of perinatal infections per 100,000 could be additionally averted if switching to the selective vaccination. The current vaccination is a dominated strategy both from the societal and payer’s perspective. The Incremental Cost-Effectiveness Ratio (ICER) between universal and selective vaccination is $267 from the societal perspective and is reported as $273 from the payer’s perspective. Conclusion Based on the assumption that the 2012 Gross Domestic Product (GDP) per capita in North Korea, $582.6 was set for cost-effectiveness criteria, the result of this study indicates that selective vaccination may be a highly cost-effective strategy compared to universal vaccination.
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Affiliation(s)
- Donghoon Lee
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Sang Min Park
- Department of Biomedical Sciences & Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
- * E-mail:
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Gibson E, Begum N, Sigmundsson B, Sackeyfio A, Hackett J, Rajaram S. Economic evaluation of pediatric influenza immunization program compared with other pediatric immunization programs: A systematic review. Hum Vaccin Immunother 2016; 12:1202-16. [PMID: 26837602 PMCID: PMC4963059 DOI: 10.1080/21645515.2015.1131369] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 11/23/2015] [Accepted: 12/08/2015] [Indexed: 01/07/2023] Open
Abstract
This study compared the economic value of pediatric immunisation programmes for influenza to those for rotavirus (RV), meningococcal disease (MD), pneumococcal disease (PD), human papillomavirus (HPV), hepatitis B (Hep B), and varicella reported in recent (2000 onwards) cost-effectiveness (CE) studies identified in a systematic review of PubMed, health technology, and vaccination databases. The systematic review yielded 51 economic evaluation studies of pediatric immunisation - 10 (20%) for influenza and 41 (80%) for the other selected diseases. The quality of the eligible articles was assessed using Drummond's checklist. Although inherent challenges and limitations exist when comparing economic evaluations of immunisation programmes, an overall comparison of the included studies demonstrated cost-effectiveness/cost saving for influenza from a European-Union-Five (EU5) and United States (US) perspective; point estimates for cost/quality-adjusted life-years (QALY) from dominance (cost-saving with more effect) to ≤45,444 were reported. The economic value of influenza programmes was comparable to the other vaccines of interest, with cost/QALY in general considerably lower than RV, Hep B, MD and PD. Independent of the perspective and type of analysis, the economic impact of a pediatric influenza immunisation program was influenced by vaccine efficacy, immunisation coverage, costs, and most significantly by herd immunity. This review suggests that pediatric influenza immunisation may offer a cost effective strategy when compared with HPV and varicella and possibly more value compared with other childhood vaccines (RV, Hep B, MD and PD).
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Komatsu H. Hepatitis B virus: Where do we stand and what is the next step for eradication? World J Gastroenterol 2014; 20:8998-9016. [PMID: 25083074 PMCID: PMC4112872 DOI: 10.3748/wjg.v20.i27.8998] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 12/09/2013] [Accepted: 04/16/2014] [Indexed: 02/06/2023] Open
Abstract
Hepatitis B (HB) virus (HBV) infection, which causes liver cirrhosis and hepatocellular carcinoma, is endemic worldwide. Hepatitis B vaccines became commercially available in the 1980s. The World Health Organization recommended the integration of the HB vaccine into the national immunisation programs in all countries. HBV prevention strategies are classified into three groups: (1) universal vaccination alone; (2) universal vaccination with screening of pregnant women plus HB immune globulin (HBIG) at birth; and (3) selective vaccination with screening of pregnant women plus HBIG at birth. Most low-income countries have adopted universal vaccine programs without screening of pregnant women. However, HB vaccines are not widely used in low-income countries. The Global Alliance for Vaccine and Immunization was launched in 2000, and by 2012, the global coverage of a three-dose HB vaccine had increased to 79%. The next challenges are to further increase the coverage rate, close the gap between recommendations and routine practices, approach high-risk individuals, screen and treat chronically infected individuals, and prevent breakthrough infections. To eradicate HBV infections, strenuous efforts are required to overcome socioeconomic barriers to the HB vaccine; this task is expected to take several decades to complete.
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Nau JY. [Hepatitis B: is it safe to pay for incentives to get vaccinated?]. Rev Med Suisse 2014; 10:892-893. [PMID: 24834654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Jia Y, Li L, Cui F, Zhang D, Zhang G, Wang F, Gong X, Zheng H, Wu Z, Miao N, Sun X, Zhang L, Lv J, Yang F. Cost-effectiveness analysis of a hepatitis B vaccination catch-up program among children in Shandong Province, China. Hum Vaccin Immunother 2014; 10:2983-91. [PMID: 25483678 PMCID: PMC5443099 DOI: 10.4161/hv.29944] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 07/02/2014] [Accepted: 07/15/2014] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The aim of the study was to estimate long-term cost‑effectiveness of a hepatitis B vaccination catch-up program among children born between 1994 and 2001 (when they were 8‑15 y old) in Shandong province, China, to provide information for nationwide evaluation and future policy making. METHODS We determined the cost-effectiveness of the catch-up program compared with the status quo (no catch-up program). We combined a Decision Tree model and a Markov model to simulate vaccination and clinical progression after hepatitis B virus (HBV) infection. Parameters in the models were from the literature, a field survey, program files, and the National Notifiable Disease Reporting System (NNDRS). The incremental cost‑effectiveness ratio (ICER) was used to compare the 2 alternative strategies. One-way sensitivity analysis, 2-way sensitivity analysis, and probability sensitivity analysis were used to assess parameter uncertainties. RESULTS The catch-up program was dominant compared with the status quo. Using a total of 5.53 million doses of vaccines, the catch-up program could prevent 21,865 cases of symptomatic acute hepatitis B, 3,088 carrier states with positive hepatitis B surface antigen (HBsAg), and 812 deaths due to HBV infection. The catch-up program could add 28,888 quality-adjusted life years (QALYs) and save $192.01 million in the targeted population in the future. The models were robust, considering parameter uncertainties. CONCLUSION The catch-up program in Shandong province among children born between 1994 and 2001 was 'very cost-saving.' It could save life years and reduce total future costs. Our study supported the desirability and impact of such a catch-up program throughout China.
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Key Words
- Anti-HBs, Antibody to Hepatitis B Surface Antigen
- CC, Compensated Cirrhosis
- CHB, Chronic Hepatitis B
- Cost-effectiveness Analysis
- DC, Decompensated Cirrhosis
- GAVI, Global Alliance on Vaccines and Immunization
- GDP, Gross Domestic Product; BCR, Benefit-Cost Ratio
- HBV, Hepatitis B Virus
- HBsAg, Hepatitis B Surface Antigen
- HCC, Hepatocellular Carcinoma
- HRQoL, Health-Related Quality of Life
- HepB3, 3-dose Coverage of Hepatitis B Vaccine
- ICER
- ICER, Incremental Cost-Effectiveness Ratio
- LT-1, the Year of Liver Transplantation
- LT-2, Years after Liver Transplantation
- MOH, Ministry of Health
- NNDRS, National Notifiable Diseases Reporting System
- QALY
- QALYs, Quality-Adjusted Life Years
- catch-up program
- hepatitis B virus
- vaccination
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Affiliation(s)
- Yuanxi Jia
- Chinese Center for Disease Control and Prevention; Beijing, China
| | - Li Li
- Chinese Center for Disease Control and Prevention; Beijing, China
| | - Fuqiang Cui
- Chinese Center for Disease Control and Prevention; Beijing, China
| | - Dongliang Zhang
- Ningbo Center for Disease Control and Prevention; Ningbo, Zhejiang, China
| | - Guomin Zhang
- Chinese Center for Disease Control and Prevention; Beijing, China
| | - Fuzhen Wang
- Chinese Center for Disease Control and Prevention; Beijing, China
| | - Xiaohong Gong
- Chinese Center for Disease Control and Prevention; Beijing, China
| | - Hui Zheng
- Chinese Center for Disease Control and Prevention; Beijing, China
| | - Zhenhua Wu
- Chinese Center for Disease Control and Prevention; Beijing, China
| | - Ning Miao
- Chinese Center for Disease Control and Prevention; Beijing, China
| | - Xiaojin Sun
- Chinese Center for Disease Control and Prevention; Beijing, China
| | - Li Zhang
- Shandong Center for Disease Control and Prevention; Jinan, Shandong, China
| | - Jingjing Lv
- Shandong Center for Disease Control and Prevention; Jinan, Shandong, China
| | - Feng Yang
- Qingdao Center for Disease Control and Prevention; Qingdao, Shandong, China
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Shi G, Zhang SX. [Decision tree and cost-benefit analysis on strategies related to preventing maternal-infantile transmission of hepatitis B virus infection]. Zhonghua Liu Xing Bing Xue Za Zhi 2013; 34:273-278. [PMID: 23759236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To synthesize relevant data and to analyze the benefit-cost ratio on strategies related to preventing the maternal-infantile transmission of hepatitis B virus infection and to explore the optimal strategy. METHODS A decision tree model was constructed according to the strategies of hepatitis B immunization and a Markov model was conducted to simulate the complex disease progress after HBV infection. Parameters in the models were drawn from meta-analysis and information was collected from field study and review of literature. Economic evaluation was performed to calculate costs, benefit, and the benefit-cost ratio. Sensitivity analysis was also conducted and a tornado graph was drawn. RESULTS In view of the current six possible strategies in preventing maternal-infantile transmission of hepatitis B virus infection, a multi-stage decision tree model was constructed to screen hepatitis B surface antigen (HBsAg) or screen for HBsAg then hepatitis B e antigen (HBeAg). Dose and the number of injections of HBIG and hepatitis B vaccine were taken into consideration in the model. All the strategies were considered to be cost-saving, while the strategy of screening for HBsAg and then offering hepatitis B vaccine of 10 µg×3 for all neonates with hepatitis B immunoglobulin (HBIG) of 100 IU×1 for the neonates born to mothers who tested positive for HBsAg appeared with most cost-saving. In the strategies, the benefit-cost ratio of using 100 IU HBIG was similar to 200 IU HBIG, and one shot of HBIG was superior to two shots. RESULTS from sensitivity analysis suggested that the rates of immunization and the efficacy of the strategy in preventing maternal-infantile transmission were the main sensitive variables in the model. CONCLUSION The passive-active immune-prophylaxis strategy that using 10 µg hepatitis B vaccine combined with 100 IU HBIG seemed to be the optimal strategy in preventing maternal-infantile transmission, while the rates of immunization and the efficacy of the strategy played the key roles in choosing the ideal strategy.
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Affiliation(s)
- Guo Shi
- College of Public Health, Zhengzhou University, China
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Lu SQ, McGhee SM, Xie X, Cheng J, Fielding R. Economic evaluation of universal newborn hepatitis B vaccination in China. Vaccine 2013; 31:1864-9. [PMID: 23384752 DOI: 10.1016/j.vaccine.2013.01.020] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 01/11/2013] [Accepted: 01/14/2013] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To estimate the long-term cost-effectiveness of universal newborn hepatitis B vaccination in China, an area of high endemicity. METHOD A decision tree was used to describe perinatal hepatitis B virus (HBV) transmission, early infection and impact of vaccination. A Markov model based on 1-year cycles was used to simulate these impacts for the lifetime of a cohort of 10,000,000 infants born in 2002 in China. We compared both cost and health outcomes for two strategies: universal newborn vaccination comprising a timely birth dose (HepB1) with a three-dose vaccination (HepB3) compared with no vaccination. Univariate and probabilistic sensitivity analyses using Monte Carlo simulations were performed to test parameter uncertainty. RESULTS Over the cohort's lifetime, 79,966 chronic infections, 37,553 cases of hepatocellular carcinoma (HCC) and 130,796 HBV related deaths would be prevented by universal infant vaccination. The prevalence of HBV infection is reduced by 76%. Over 743,000 life-years and 620,000 quality adjusted life years (QALYs) would be gained and there would be monetary benefits of more than 1 billion US dollars in medical care costs and lost productivity avoided. CONCLUSION The newborn vaccination programme for Hepatitis B in China both gains QALYs and saves medical care costs. It is important to ensure that timely and comprehensive vaccination programmes continue.
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Affiliation(s)
- Sandy Qiuying Lu
- Department of Community Medicine, School of Public Health, the University of Hong Kong, Hong Kong Special Administrative Region, China
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Centers for Disease Control and Prevention (CDC). Use of hepatitis B vaccination for adults with diabetes mellitus: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2011; 60:1709-11. [PMID: 22189894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Hepatitis B virus (HBV) causes acute and chronic infection of the liver leading to substantial morbidity and mortality. In the United States, since 1996, a total of 29 outbreaks of HBV infection in one or multiple long-term-care (LTC) facilities, including nursing homes and assisted-living facilities, were reported to CDC; of these, 25 involved adults with diabetes receiving assisted blood glucose monitoring. These outbreaks prompted the Hepatitis Vaccines Work Group of the Advisory Committee on Immunization Practices (ACIP) to evaluate the risk for HBV infection among all adults with diagnosed diabetes. The Work Group reviewed HBV infection-related morbidity and mortality and the effectiveness of implementing infection prevention and control measures. The strength of scientific evidence regarding protection was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology,* and safety, values, and cost-effectiveness were incorporated into a recommendation using the GRADE system. Based on the Work Group findings, on October 25, 2011, ACIP recommended that all previously unvaccinated adults aged 19 through 59 years with diabetes mellitus (type 1 and type 2) be vaccinated against hepatitis B as soon as possible after a diagnosis of diabetes is made (recommendation category A). Data on the risk for hepatitis B among adults aged ≥60 years are less robust. Therefore, ACIP recommended that unvaccinated adults aged ≥60 years with diabetes may be vaccinated at the discretion of the treating clinician after assessing their risk and the likelihood of an adequate immune response to vaccination (recommendation category B). This report summarizes these recommendations and provides the rationale used by ACIP to inform their decision making.
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Chen RT, Hu DJ, Dunne E, Shaw M, Mullins JI, Rerks-Ngarm S. Preparing for the availability of a partially effective HIV vaccine: some lessons from other licensed vaccines. Vaccine 2011; 29:6072-8. [PMID: 21745523 DOI: 10.1016/j.vaccine.2011.07.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Robert T Chen
- Centers for Disease Control and Prevention, Atlanta, GA 30333, United States.
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Centers for Disease Control and Prevention (CDC). The Adult Hepatitis Vaccine Project - California, 2007-2008. MMWR Morb Mortal Wkly Rep 2010; 59:514-6. [PMID: 20448527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Since hepatitis B vaccine was first released in 1981, a public health goal has been to vaccinate adults at risk for infection because of risky sexual behaviors and needle-sharing practices. However, vaccination coverage for this group has remained low. During 2007, in the United States, among the estimated 43,000 persons newly infected with hepatitis B virus (HBV), the highest rate was reported among persons aged 25-44 years, and the majority of these infections were among at-risk adults. Surveillance data were similar in California. In 2006, when the Advisory Committee on Immunization Practices (ACIP) recommended that hepatitis B vaccination be offered to all adults as part of routine prevention services in settings where a high proportion of those served are at increased risk, CDC launched a national initiative encouraging states to use existing federal funds to purchase adult hepatitis B--containing (HepB) vaccine. In response, the California Department of Public Health (CDPH) established the Adult Hepatitis Vaccine Project (AHVP) to expand hepatitis B vaccination in sites serving at-risk adults. This report summarizes results for 2007-2008, which indicated that 28,824 doses of HepB vaccine were administered at 29 participating sites in the first 19 months of AHVP; 13 sites administered HepB vaccine for the first time. Federal provision of vaccine resulted in vaccination of many adults who otherwise might not have been vaccinated against HBV. Increased capacity to vaccinate all adults at risk is needed for the elimination of HBV transmission in the United States.
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Gaudelus J. [Mobilize parents to vaccinate their children against hepatitis B: the role of the pediatrician]. Arch Pediatr 2010; 17:6-13. [PMID: 20304345 DOI: 10.1016/s0929-693x(10)70008-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Joël Gaudelus
- Service de pédiatrie, Hôpital Jean-Verdier, avenue du 14 juillet 93143 Bondy, France
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Díez Redondo MP, Almaraz A, Jiménez Rodríguez-Vila M, Santamaría A, de Castro J, Torrego JC, Caro-Patón A. Comparison of two vaccination strategies against hepatitis A and B in patients with chronic hepatitis C. Rev Esp Enferm Dig 2009; 101:265-274. [PMID: 19492902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE although the vaccination against hepatitis A (VAH) and hepatitis B (VBH) is recommended in patients with HCV, the most cost-effective strategy has not been established. Our objective was to compare the cost-effectiveness of universal strategy (vaccination all patients) with selective strategy (vaccination only patients against virus they lack immunity to) in patients with HCV. PATIENTS AND METHODS we compared the direct medical costs of the two vaccination strategies against both viruses in 313 patients with HC. Serological markers for HAV (anti-HAV) and HBV (HbsAg, anti HBs, anti HBc) were determined in the 313 patients and the costs of the vaccines and the blood tests necessary to determinate the immunity state in our care system were considered. RESULTS the prevalence of anti-HAV was 81,2% and of anti-HBc was 24,6%. The prevalence of anti-HAV increases with age. HAV vaccination with universal strategy has a cost of 19.806,64 euro and with selective one of 9.899,62 euro. HBV vaccination with universal strategy rose to 18.780 euro and to 20.385,57 euro with selective one (employing anti-HBc). Costs were analysed in different groups of age and several hepatitis HBV risk factors. CONCLUSIONS the selective vaccination strategy against HAV was most cost-effective in our patients with HCV. However, when the prevalence of the anti-HAV decreased to less than 20% universal strategy will be the best option. Difference of cost-effective between the two vaccination strategies against HBV was small, on behalf of universal one, so in groups with higher anti-HBc prevalence, like parenteral drugs users and tattoos, the selective strategy could be the best option.
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Affiliation(s)
- M P Díez Redondo
- Service of Digestive diseases, Hospital Universitario Río Hortega, Department of Mibrobiology en Pre-emptive Medicine, School of Medicine, Valladolid, Spain.
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Zhang SX, Dang RB, Zhang WD, Liang XF, Cui FQ. [Analysis on economic efficacy regarding previous strategies and current recommendations for vaccination against hepatitis B virus in China]. Zhonghua Liu Xing Bing Xue Za Zhi 2008; 29:1003-1008. [PMID: 19173882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To evaluate the outcome of hepatitis B vaccination strategies performed over the past 14 years and different alternatives recommended for future immunization programs from the point of view of economic efficacy. METHODS Methods used would include: process of decision analysis including building the tree; populating the model with parameters; estimating expected cost benefit and effectiveness and deterministic and probabilistic sensitivity and threshold analysis. RESULTS In China, over the past 14 years from 1992 to 2005, around 5.348 billion Chinese Yuan were provided for hepatitis B vaccination but the total benefits were 272.825 billion Yuan, with net benefits as 267.477 billion Yuan. The cost for each infection averted was 81.99 Yuan while the benefit of one Yuan being invested had 51.01 Yuan in return. For the future recommendations, data from the study revealed that the priority of hepatitis B vaccination for newborns and vaccinations plus passive immunization of newborns of HBsAg positive mothers were most effective approaches. If the other population as adolescents was included into the vaccination program, then screening for hepatitis B virus markers before accepting the vaccination appeared to be one of the most cost-saving strategies. Sensitivity and threshold analyses showed that hepatitis B virus marker was the most important factor, followed by the cost of vaccine, vaccination coverage and vaccine efficacy, in order. CONCLUSION Routine vaccination of infants in successive birth cohorts to prevent HBV transmission was a cost-effective strategy administrated over the past 14 years in China. In the following years, the immunization of newborns was still the preferential strategy from a societal perspective. However, vaccination provided to other population including adolescents seemed economically less attractive.
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Affiliation(s)
- Shun-xiang Zhang
- Shenzhen Center for Disease Control and Prevention, Shenzhen 518020, China
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Hu Y, Grau LE, Scott G, Seal KH, Marshall PA, Singer M, Heimer R. Economic evaluation of delivering hepatitis B vaccine to injection drug users. Am J Prev Med 2008; 35:25-32. [PMID: 18541174 PMCID: PMC2483306 DOI: 10.1016/j.amepre.2008.03.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Revised: 12/17/2007] [Accepted: 03/11/2008] [Indexed: 01/05/2023]
Abstract
BACKGROUND Injection drug users (IDUs) are at high risk of hepatitis B (HBV) infection, and hepatitis B vaccination coverage in IDUs is low. Recent studies demonstrate that syringe exchange programs are effective venues to reach and immunize IDUs. The purpose of this paper was to determine if targeting IDUs for HBV vaccination through syringe exchange programs is economically desirable for the healthcare system and to assess the relative effectiveness of several different vaccination strategies. METHODS Active IDUs in Chicago IL and Hartford and Bridgeport CT (N=1964) were recruited and screened through local syringe exchange programs, randomized to a standard (0, 1, 6 months) or accelerated (0, 1, 2 months) vaccination schedule, and followed from May 2003 to March 2006. Analyses were conducted in 2007. The vaccination program's costs were balanced against future HBV-associated medical costs. Benefits in terms of prevented acute HBV infections and quality-adjusted life years were estimated based on a Markov model. RESULTS HBV vaccination campaigns targeting IDUs through syringe exchange programs are cost-saving. The most cost-saving strategies include giving the first dose to everyone at screening, administering the vaccination under the accelerated schedule (0, 1, 2 months), and obtaining highly discounted vaccine from local health departments. CONCLUSIONS It is economically inappropriate to offer HBV screening in the absence of vaccination. Existing syringe exchange programs in the U.S. should include HBV vaccination.
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Affiliation(s)
- Yiqing Hu
- Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut 06520-8034, USA.
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Mathew A. Global access to vaccines: Vaccine sale is not tailored to improving India's health. BMJ 2008; 336:975. [PMID: 18456606 PMCID: PMC2364820 DOI: 10.1136/bmj.39563.536157.be] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Puliyel JM, Rastogi P, Mathew JL. Hepatitis B in India: Systematic review & report of the 'IMA sub-committee on immunization'. Indian J Med Res 2008; 127:494-7. [PMID: 18653915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
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Micozkadioglu H, Zumrutdal A, Torun D, Sezer S, Ozdemir FN, Haberal M. Low dose intradermal vaccination is superior to high dose intramuscular vaccination for hepatitis B in unresponsive hemodialysis patients. Ren Fail 2008; 29:285-8. [PMID: 17497441 DOI: 10.1080/08860220601166263] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
After two intramuscular (IM) vaccination protocols (40 microg at 0, 1, 2, and 6 months), patients who were unresponsive to hepatitis B vaccination were collected from three HD centers. The aim of this study was to compare the effectiveness of intradermal (ID) and repeated IM vaccination protocols. Thirty-three of 639 HD patients were found to be unresponsive. Patients were randomly assigned into two groups: one to receive 80 microg ID and the other 160 microg IM vaccination protocol. Both ID (p = 0.000) and IM (p = 0.03) groups disclosed statistically significant seroconversion rates six months after the last vaccination dose. The seroconversion rate was 94.1% in the ID and 50% in the IM groups - showing a significant improvement in the ID group (p = 0.011). A low-dose ID is superior to standard IM vaccination protocol and also more cost-effective in unresponsive HD patients.
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Affiliation(s)
- Hasan Micozkadioglu
- Department of Nephrology, Baskent University Faculty of Medicine, Hospital of Adana, Adana, Turkey.
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Mengal HUR, Howteerakul N, Suwannapong N, Rajatanun T. Factors relating to acceptance of hepatitis B virus vaccination by nursing students in a tertiary hospital, Pakistan. J Health Popul Nutr 2008; 26:46-53. [PMID: 18637527 PMCID: PMC2740679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This cross-sectional study aimed at assessing the prevalence of, and factors relating to, the acceptance of hepatitis B virus (HBV) vaccination by nursing students in a tertiary hospital in Pakistan. In total, 210 nursing students of Year 2 to Year 4 were invited to participate in the study; of them, 196 (93.3%) returned completed questionnaires. Overall, the prevalence of acceptance of HBV vaccination among them was 75.0%. Of these, 37.2% (73/196) were completely vaccinated, and 25.0% (49/196) had not been vaccinated at all. More than half (27/49, 55.1%) of the unvaccinated nursing students stated that they would accept vaccination if offered. Multiple logistic regression analysis indicated three variables significantly related to acceptance of HBV vaccination: history of accidental exposure to blood or blood products, acceptable knowledge about HBV infection, and adequate budget for HBV vaccination. Health institutions should allocate adequate budgets to vaccinate their nursing students. Effective intervention programmes designed to increase knowledge about HBV infection and adhering to universally-accepted precautions are needed.
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Velu V, Nandakumar S, Shanmugam S, Jadhav SS, Kulkarni PS, Thyagarajan SP. Comparison of three different recombinant hepatitis B vaccines: GeneVac-B, Engerix B and Shanvac B in high risk infants born to HBsAg positive mothers in India. World J Gastroenterol 2007; 13:3084-9. [PMID: 17589924 PMCID: PMC4172615 DOI: 10.3748/wjg.v13.i22.3084] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate a low cost Indian recombinant hepatitis B vaccine GeneVac-B® for its immunogenicity and safety in comparison to Engerix B® and Shanvac B® vaccine in high risk newborn infants born to hepatitis B surface antigen (HBsAg) positive mothers.
METHODS: A total of 158 infants were enrolled in the study. Fifty eight infants were enrolled in the GeneVac-B® group while 50 each were included for Engerix B® and Shanvac B® groups. A three-dose regimen of vaccination; at birth (within 24 h of birth), 1st mo and 6 mo. were adopted with 10 μg dosage administered uniformly in all the three groups. Clinical and immunological parameters were assessed for safety and immunogenicity of the vaccines, in all the enrolled infants.
RESULTS: Successful follow up until seven months of age was achieved in 83% (48/58) for GeneVac-B®, 76% (38/50) and 64% (32/50) for Engerix B® and Shanvac B® groups respectively. 100% seroconversion and seroprotection was achieved in all the three groups of infants. The geometric mean titers of anti-HBs one month after the completion of three dose of vaccination were 90.5, 80.9 and 72.5 mIU/mL in GeneVac-B®, Engerix B® and Shanvac B® vaccine group respectively. Furthermore the level of anti-HBs increases with age of babies who were born to HBsAg positive mothers. The GMT values of anti-HBs were 226.7, 193.9 and 173.6 mIU/mL respectively in GeneVac-B®, Engerix B® and Shanvac B® groups one year after the completion of the three doses of vaccine. No systemic reactions were reported in infants during the entire vaccination process of GeneVac-B® and the other two vaccines. Clinical safety parameters remained within the normal limits throughout the study period.
CONCLUSION: The study concludes that there is no significant difference between the three recombinant hepatitis B vaccines. Administration of these vaccines within 24 h of birth to babies, born to HBsAg positive mothers will reduce the incidence of HBV infection.
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Affiliation(s)
- Vijayakumar Velu
- Department of Medical Microbiology, Dr ALM PGIBMS, University of Madras, Chennai 600113 and National referral Centre for viral hepatitis, India.
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Creati M, Saleh A, Ruff TA, Stewart T, Otto B, Sutanto A, Clements CJ. Implementing the birth dose of hepatitis B vaccine in rural Indonesia. Vaccine 2007; 25:5985-93. [PMID: 17604881 DOI: 10.1016/j.vaccine.2007.05.055] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2005] [Revised: 05/17/2007] [Accepted: 05/20/2007] [Indexed: 12/13/2022]
Abstract
Reaching mothers and their newborn infants around the time of birth with adequate health services has long been a difficult problem in developing countries. In parallel, similar problems have arisen in attempting to deliver hepatitis B (HepB) vaccine to infants born at home in many countries where mother-to-infant transmission is common. It is logical, and supported by experience in Indonesia, to find a combined solution for both problems. The World Health Organization (WHO) recommends that a timely birth dose of HepB vaccine be given, particularly in areas of high vertical transmission of hepatitis B virus (HBV). This can be achieved relatively easily in situations where almost all births occur in health facilities. But where a significant proportion of births occur at home and without birth attendants able to give injections, this is much more difficult. Barriers to the timely administration of the birth dose of HepB vaccine include weakness in policy development and implementation, difficulties in reliably supplying potent vaccine to community level, limited transport, poor communication, limited cold chain capacity, lack of effective training, and lack of a clear delineation of responsibility between health care professionals. Demonstration projects, such as those in Indonesia, suggest that there are significant opportunities to improve the timely delivery of HepB vaccine birth dose in existing maternal and child health programmes where health workers are trained to provide home delivery care.
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Affiliation(s)
- Mick Creati
- Centre for International Health, The Macfarlane Burnet Institute for Medical Research and Public Health Ltd., Australia
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Abstract
Chronic hepatitis B virus infection causes nearly all the deaths from this virus. As the initial infection occurs without symptoms and decades prior to the onset of cirrhosis and liver cancer, these consequences are rarely recognized as being caused by the virus. Consequently, its public health importance is under-recognized. Safe and effective vaccines have now been available for over 20 years. Concerns have been raised regarding the mercury preservative in vaccines leading to potential toxicity. But the evidence to date does not support any association of hepatitis B vaccine with serious adverse consequences. Protecting infants through immunization is the most effective control strategy. By 2005, over 80% of countries had implemented routine infant immunization. In countries with relatively low rates of hepatitis B virus infection, some have argued to defer immunization until later life. However, these arguments focus on the more visible acute infection. The possible future cost from a single infant infection argues for universal infant hepatitis B immunization--given the very high costs of treating its consequences (e.g., liver transplant) and the very low price of the vaccine.
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Affiliation(s)
- Osman David Mansoor
- Child Survival and Immunization Unit, Health Section, Programme Division, United Nations Children's Fund (UNICEF), 3 UN Plaza, New York, NY 10017, USA.
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Abstract
OBJECTIVE On December 13, 2002, Pediarix, a combination vaccine that contains diphtheria, tetanus, acellular pertussis; hepatitis B; and inactivated polio vaccines, was licensed by the Food and Drug Administration for use in the primary immunization series. Use of this vaccine decreases the number of injections that children receive when completing their primary immunization series at the 2-, 4-, and 6-month well-child visits. The objective of this study was to determine the factors that influence the use of this combined vaccine in private pediatric practices, with particular attention to the perceived economic impact of Pediarix and actions taken to address this impact within the private pediatric setting. METHODS A mail survey study was conducted of a random sample of 565 practicing pediatricians that was obtained from the American Medical Association Masterfile. Frequency distributions were developed for all responses, and the vaccine financing policies of the state of practice for each respondent were determined. Chi2 analysis was performed to assess any associations of the predictor variables with the outcome variables of interest, use or consideration of use of the Pediarix vaccine. Logistic regression was used to determine the independent association of the predictor variables with use or consideration of use of Pediarix. Regression models that did and did not include practice ownership as a predictor variable were developed. RESULTS Response rate was 63% (N = 355). A total of 39% (n = 123) of the respondents' practices were purchasing Pediarix for use with their private patients. An additional 18% (n = 55) were considering purchasing the vaccine. Those who were in practices that were owned by hospitals or health systems were more likely than those who were in solo or group practices to purchase Pediarix for their private patients. Approximately half of the remaining respondents order Pediarix through their state immunization program. Among the 52% of respondents who did not, 23% reported that the vaccine was not yet available through their state program, and 47% stated that they did not want to use different vaccines for their public and private patients. Only 11% believed that Pediarix was not compatible with their other vaccine products. Physicians that currently were purchasing or considering purchasing Pediarix were more likely to be influenced by both parental and provider desire to decrease the number of injections at a single visit and the reduced time for immunization delivery. Fewer than 1% of respondents reported either having experienced or expecting to experience a significant decrease in practice revenue as a result of the use of Pediarix. CONCLUSIONS Although use of the vaccine results in fewer administration fees for most physicians, the magnitude of the change seemed not to be significant for the majority of respondents or was outweighed by other factors. It also is possible that larger practices or buying cooperatives were able to negotiate discounted rates for Pediarix relative to the constituent products. This may have been a strategy of manufacturers and/or distributors to provide incentive for practices to switch to the combination product. Of note was the appreciation of respondents for the preferences of patients for fewer vaccines and, to a lesser degree, for the decrease in office staff time required to provide vaccination with multiple antigens when using Pediarix. Also, the role of the availability of a given vaccine through the Vaccines for Children program is important in its adoption into practice.
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Affiliation(s)
- Gary L Freed
- Child Health Evaluation and Research Unit, University of Michigan, Ann Arbor, Michigan 48109-0456, USA.
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Mat O, Mestrez F, Beauwens R, Muniz-Martinez MC, Dhaene M. Primary high-dose intradermal hepatitis B vaccination in hemodialysis: cost-effectiveness evaluation at 2 years. Hemodial Int 2006; 10:49-55. [PMID: 16441827 DOI: 10.1111/j.1542-4758.2006.01174.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Reinforced hepatitis B (HB) vaccination schedules have been tested in nonresponsive hemodialysis (HD) patients. Primary high-dose intradermal (ID) vaccination in HD has been proposed in one study with higher seroconversion rate, but no cost analysis was made. The aim of this prospective study was to confirm this previous report and focus on a cost-effectiveness evaluation of the thorough vaccination with a maintenance program. Thirty-five chronic incident HD patients received primary ID HB vaccination with a reinforced schedule (20 microg Engerix-B every 2 weeks). Revaccination with a monthly single ID dose of 20 microg was performed whenever anti-HBs titer fell under 20 IU/L and continued until a titer of 20 U/L was reached. Outcome measures were cumulative seroconversion rates, mean levels of anti-HBs, maintenance booster doses, rate of seroprotection at the end of the 2-year follow-up and subsequent costs. The present study was associated with an earlier peak of anti-HBs titer (3.9+/-1.7 months) and a higher cumulative seroconversion rate (96.9%) after 1 year. Moreover, a low-booster shot (17.4 microg) of ID Engerix-B/year/patient confers a 100% seroprotection for all responders for a second-year period. The mean cost of our schedule is 127.7 euro/patient for a 2-year period, revaccination included. This current study demonstrates that primary reinforced ID HB vaccination with a maintenance program for a 2-year period warrants the best cost-effectiveness ratio with rapid and sustained seroprotection in almost all HD patients.
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Affiliation(s)
- Olivier Mat
- Department of Nephrology-Dialysis, R.H.M.S. of Baudour, Belgium.
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Skloot R. Taking the least of you: most of us have tissue or blood samples on file somewhere, whether we know it or not. What we don't typically know is what research they are being used for or how much money is being made from them. And science may want to keep things that way. N Y Times Mag 2006:38-45, 75, 79, 81. [PMID: 16715570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
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Abstract
Yes. But how?
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Affiliation(s)
- P English
- Surrey & Sussex Health Protection Unit, Century House, 26 Bridge Street, Leatherhead KT22 8BZ, UK.
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Kulkarni PS, Raut SK, Patki PS, Phadke MA, Jadhav SS, Kapre SV, Dhorje SP, Godse SR. Immunogenicity of a new, low-cost recombinant hepatitis B vaccine derived from Hansenula polymorpha in adults. Vaccine 2006; 24:3457-60. [PMID: 16530299 DOI: 10.1016/j.vaccine.2006.02.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2005] [Revised: 02/04/2006] [Accepted: 02/06/2006] [Indexed: 01/25/2023]
Abstract
BACKGROUND Hepatitis B virus (HBV) infection is highly prevalent world over, especially in developing countries. A new recombinant hepatitis B virus (GeneVac-B; Serum Institute of India Ltd.) vaccine is developed using Hansenula polymorpha yeast. We decided to assess the immunogenicity, and reactogenicity of this vaccine in a large adult population. MATERIAL AND METHODS Seven hundred eighty-eight adults subjects (age: 19-57 years, male:female ratio 35:1) received three 20 microg doses of a H. polymorpha-derived recombinant hepatitis B vaccine in months 0, 1, and 6. All the eligible subjects had negative baseline serum HBs Ag, and anti-HBs. The anti-HBs titer was obtained 1 month after the last dose of vaccine and was considered seroconverted if more than 1 mIU/ml, and seroprotective if more than 10 mIU/ml. RESULTS The seroprotection rate was 96% and seroconversion rate was 97%. Seroconversion and seroprotection rates declined with increasing age. The minimum geometric mean titre of anti HBs was 443 mIU/ml (95% CI 407-482). Seroprotection was 96% in age group<40 years, while the same was 91% in >40 years group (Odd's ratio-2.9100, Z value-2.6183, highly significant). No other factor like smoking, tobacco-chewing, alcohol consumption, chronic diseases, and obesity, affected the immune response. No significant adverse reactions were reported in any of the subjects. CONCLUSIONS Three standard doses of the H. polymorpha-derived recombinant HBV vaccine are highly immunogenic and safe in a predominantly male adult population. Young adults respond better with this vaccine. Because of its low cost, the vaccine may be a good choice in prevention of hepatitis B infection.
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Affiliation(s)
- P S Kulkarni
- Serum Institute of India Ltd., 212/2, Hadapsar, Pune 411028, India.
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Ringwald J, Mertz I, Zimmermann R, Weisbach V, Strasser E, Achenbach S, Seyboth S, Richter E, Eckstein R. Hepatitis B virus vaccination of blood donors--what costs may be expected? Transfus Med 2005; 15:83-92. [PMID: 15859973 DOI: 10.1111/j.0958-7578.2005.00556.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Although the risk of transfusion-transmitted hepatitis B virus (TT-HBV) infection is very low, it still exists. Therefore, introduction of further precautions to reduce this risk is discussed at present. However, so far no data are available about the HBV vaccination status among blood donors (BDs). We compared HBV vaccination status of apheresis donors (ADs) of a university based and whole BDs (WBDs) of a Red Cross blood donation service using a standardized questionnaire. On the basis of these data, the estimated costs over 10 years for HBV vaccination were calculated for two different strategies and compared with the costs for HBV nucleic acid amplification technology (NAT) testing. 22.3% of the WBDs and 41.2% of the ADs indicated having received at least one HBV vaccine dose. This difference was related to the different demographic structures of the two BD populations (BDPs). With regard to the primary costs for the blood donation service, HBV vaccination of BDs could be an alternative to HBV NAT testing, especially for BDPs with an already high HBV vaccination rate and a high donation frequency.
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Affiliation(s)
- J Ringwald
- Department of Transfusion Medicine and Haemostaseology, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany.
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Wallace LA, Young D, Brown A, Cameron JC, Ahmed S, Duff R, Carman WF, Kitchin NRE, Nguyen-Van-Tam JS, Goldberg DJ. Costs of running a universal adolescent hepatitis B vaccination programme. Vaccine 2005; 23:5624-31. [PMID: 16099079 DOI: 10.1016/j.vaccine.2005.06.034] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2004] [Accepted: 06/01/2005] [Indexed: 11/29/2022]
Abstract
In the first UK study to examine feasibility and acceptability of universal adolescent hepatitis B vaccination, the costs associated with the administration and uptake (80.2 and 89.3% for three doses and at least two doses, respectively), of a three-dose regimen in pupils in Glasgow schools (2001/2002) were measured. These data were used to estimate the economic outlay for the delivery of a routine, ongoing three-dose and two-dose hepatitis B vaccine programme in schools. Vaccine, accounting for almost 70% of the overall costs, was the largest cost item for both the pilot and routine programmes, using either regimen. However, the ongoing, two-dose regimen was the cheapest option in this analysis, irrespective of vaccine price. Cost data from this study may be useful for other countries wishing to implement a similar programme.
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Affiliation(s)
- L A Wallace
- Health Protection Scotland, Clifton House, Clifton Place, Glasgow G3 7LN, UK.
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Levin CE, Nelson CM, Widjaya A, Moniaga V, Anwar C. The costs of home delivery of a birth dose of hepatitis B vaccine in a prefilled syringe in Indonesia. Bull World Health Organ 2005; 83:456-461. [PMID: 15976897 PMCID: PMC2626261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
OBJECTIVE To provide global policy-makers with decision-making information for developing strategies for immunization of infants with a birth dose of hepatitis B vaccine, this paper presents a retrospective cost analysis, conducted in Indonesia, of delivering this vaccine at birth using the Uniject prefill injection device. METHODS Incremental costs or cost savings associated with changes in the hepatitis B immunization programme were calculated using sensitivity analysis to vary the estimates of vaccine wastage rates and prices for vaccines and injection devices, for the birth dose of hepatitis B vaccine. FINDINGS The introduction of hepatitis B vaccine prefilled in Uniject (HB-Uniject) single-dose injection devices for use by midwives for delivering the birth dose is cost-saving when the wastage rate for multidose vials is greater than 33% (Uniject is a trademark of BD, Franklin Lakes, NJ, USA). CONCLUSION The introduction of HB-Uniject for birth-dose delivery is economically worthwhile and can increase coverage of the critical birth dose, improve resource utilization, reduce transmission of hepatitis B and promote injection safety.
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Affiliation(s)
- Carol E Levin
- Program for Appropriate Technology in Health, Seattle, WA 98107, USA.
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Griffiths UK, Hutton G, Das Dores Pascoal E. The cost-effectiveness of introducing hepatitis B vaccine into infant immunization services in Mozambique. Health Policy Plan 2005; 20:50-9. [PMID: 15689430 DOI: 10.1093/heapol/czi006] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To estimate the cost-effectiveness of introducing hepatitis B vaccine into routine infant immunization services in Mozambique, which took place in the year 2001. METHODS A decision analytic model was used to estimate the impact of hepatitis B vaccination. This model was developed for the WHO to estimate the global burden of disease from hepatitis B. Cost data of vaccine delivery and medical treatment related to hepatitis B infection were collected for the analysis. FINDINGS The introduction of hepatitis B vaccine has increased the annual budget for immunization services by approximately 56%. It is predicted that more than 4000 future deaths are averted annually by the intervention. In the base case scenario, the incremental costs per undiscounted deaths averted amount to US$436, and the costs per undiscounted DALY averted amount to US$36. Since the major impact of hepatitis B vaccination will not start to be evident for at least another 40 years (deaths from hepatitis B mainly occur between 40-60 years of age), the cost per DALY averted rises to US$47, when using a discount rate of 3% on health effects. We found that the monovalent hepatitis B vaccine was considerably more cost-effective than the hepatitis B vaccine in combination with DTP. INTERPRETATION If policy makers value future health benefits equal to current benefits, the cost-effectiveness of infant hepatitis B vaccination is in the range of other primary health care interventions for which similar analysis has been undertaken.
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Affiliation(s)
- Ulla K Griffiths
- Department of Vaccines and Biologicals, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland.
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Navas E, Salleras L, Gisbert R, Dominguez A, Bruguera M, Rodríguez G, Galí N, Prat A. Efficiency of the incorporation of the hepatitis A vaccine as a combined A+B vaccine to the hepatitis B vaccination programme of preadolescents in schools. Vaccine 2005; 23:2185-9. [PMID: 15755592 DOI: 10.1016/j.vaccine.2005.01.065] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In 1998, the Department of Health of Catalonia (Spain) began universal vaccination of preadolescents against hepatitis A by replacing the simple hepatitis B vaccine with a combined hepatitis A+B vaccine. Economic analyses were made of the two alternative strategies: to continue with the simple hepatitis B vaccination or to replace the simple vaccine with a combined hepatitis A+B vaccine. The analysis was made from the societal perspective and the time horizon considered was 25 years. In the base case, (estimated annual hepatitis A incidence of 15 per 100,000 and incremental price of the hepatitis A+B vaccine over the simple hepatitis B vaccine of 1.98) the net present value of the programme was positive (+533,708) and the benefit-cost ratio was 2.58. If the estimated disease incidence were reduced by half, the programme would still be efficient.
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Affiliation(s)
- E Navas
- General-Directorate of Public Health, Department of Health, Generalitat of Catalonia, Travessera de les Corts, 131-159, 08028 Barcelona, Spain.
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Vimolket T, Poovorawan Y. An economic evaluation of universal infant vaccination strategies against hepatitis B in Thailand: an analytic decision approach to cost-effectiveness. Southeast Asian J Trop Med Public Health 2005; 36:693-9. [PMID: 16124440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
To evaluate the cost-effectiveness of four infant vaccination strategies aimed at protecting the Thai population against hepatitis B virus (HBV) infection, vaccination and giving hepatitis B immunoglobulin (HBIg) to high-risk infants were compared with universal vaccination of infants and no vaccination. An analytic decision model was used to estimate the clinical and economic consequences of HBV for a hypothetical cohort of newborns for each of the immunization strategies. The model focused on the numbers and the costs of cases prevented. The decision model examined four different HBV management strategies: 1. screening for HBsAg, and vaccination; 2. screening for HBsAg, then HBeAg, and vaccination; 3. universal vaccination of all neonates; and 4. no vaccination. The cost-effectiveness per case prevented for Strategy 1 was 292.79 baht; for Strategy 2, 264.34 baht; for Strategy 3, 151.05 baht; and for Strategy 4, 0 baht. The incremental cost comparing Strategy 3 to Strategy 4 was 6,521 baht; comparing Strategy 2 to Strategy 3, 20,000 baht; and comparing Strategy 1 to Strategy 2, 95,000 baht. There is no socially acceptable threshold value for cost per case prevented to guide decisions on funding health care interventions. Strategy 3 should certainly be continued. Nevertheless, based on these results, Strategy 2 may be considered, despite the incremental cost being about 2 times that of Strategy 3, as it might represent a worthwhile investment of public funds.
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Affiliation(s)
- Thosporn Vimolket
- Department of Preventive Medicine, Chulalongkorn University, Bangkok, Thailand
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Agarwal KS. "Do-nothing" alternative and cost-minimization evaluations. Indian J Gastroenterol 2005; 23:194; author reply 194-5. [PMID: 15599014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Puliyel JM. Policy analysis of the use of Hepatitis B, Hemophilius influenzae type B, Steptococcus pneuomniae-conjugate and Rotavirus vaccines in the national immunization schedules. Health Econ 2004; 13:1147-1148. [PMID: 15547938 DOI: 10.1002/hec.960] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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Jacobs RJ, Gibson GA, Meyerhoff AS. Cost-effectiveness of hepatitis A-B vaccine versus hepatitis B vaccine for healthcare and public safety workers in the western United States. Infect Control Hosp Epidemiol 2004; 25:563-9. [PMID: 15301028 DOI: 10.1086/502440] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To determine the cost-effectiveness of substituting hepatitis A-B vaccine for hepatitis B vaccine when healthcare and public safety workers in the western United States are immunized to protect against occupational exposures to hepatitis B. PARTICIPANTS A cohort of 100,000 hypothetical healthcare and public safety workers from 11 western states with hepatitis A rates twice the national average. DESIGN A Markov model of hepatitis A was developed using estimates from U.S. government databases, published literature, and an expert panel. Added costs of hepatitis A-B vaccine were compared with savings from reduced hepatitis A treatment and work loss. Cost-effectiveness was expressed as the ratio of net costs to quality-adjusted life-years (QALYs) gained. RESULTS Substituting hepatitis A-B vaccine would prevent 29,796 work-loss-days, 222 hospitalizations, 6 premature deaths, and the loss of 214 QALYs. Added vaccination costs of $5.4 million would be more than offset by $1.9 million and $6.1 million reductions in hepatitis A treatment and work loss costs, respectively. Cost-effectiveness improves as the time horizon is extended, from $232,600 per QALY after 1 year to less than $0 per QALY within 11 years. Estimates are most sensitive to community-wide hepatitis A rates and the degree to which childhood vaccination may reduce future rates. CONCLUSION For healthcare and public safety workers in western states, substituting hepatitis A-B vaccine for hepatitis B vaccine would reduce morbidity, mortality, and costs.
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Affiliation(s)
- R Jake Jacobs
- Capitol Outcomes Research, Inc., Alexandria, Virginia 22310, USA
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Varghese RM, Abraham J, James J, Puliyel JM. Determining the point of indifference--where costs of selective and universal immunization against hepatitis B are identical, in a cost-minimization exercise. Indian J Gastroenterol 2004; 23:154-6. [PMID: 15333982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Adibi P, Rezailashkajani M, Roshandel D, Behrouz N, Ansari S, Somi MH, Shahraz S, Zali MR. An economic analysis of premarriage prevention of hepatitis B transmission in Iran. BMC Infect Dis 2004; 4:31. [PMID: 15347430 PMCID: PMC517713 DOI: 10.1186/1471-2334-4-31] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2004] [Accepted: 09/04/2004] [Indexed: 02/03/2023] Open
Abstract
Background To assess the economic aspects of HBV (hepatitis B virus) transmission prevention for premarriage individuals in a country with cultural backgrounds like Iran and intermediate endemicity of HBV infection. Methods A cost-effectiveness analysis model was used from the health care system and society perspectives. The effectiveness was defined as the number of chronic HBV infections averted owing to one of the following strategies: 1) HBsAg screening to find those would-be couples one of whom is HBsAg positive and putting seronegative subjects on a protection protocol comprising HBV vaccination, single dose HBIG and condom protection. 2) HBsAg screening as above, in addition to performing HBcAb screening in the HBsAg negative spouses of the HBsAg positive persons and giving the protocol only to HBcAb negative ones. Sensitivity and threshold analyses were conducted. Results The cost of each chronic infection averted was 202$ and 197$ for the strategies 1 and 2, respectively. Sensitivity analysis showed that strategy 2 was always slightly cheaper than strategy 1. The discounted threshold value for the lifetime costs of chronic liver disease, above which the model was cost saving was 2818$ in strategy 1 and 2747$ in strategy 2. Conclusions Though premarriage prevention of HBV transmission in the countries with cultural backgrounds similar to Iran seems cost saving, further studies determining precise costs of HBV infection in Iran can lead to a better analysis.
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Affiliation(s)
- Peyman Adibi
- Research Center for Gastroenterology and Liver Disease, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Rezailashkajani
- Research Center for Gastroenterology and Liver Disease, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - Delnaz Roshandel
- Research Center for Gastroenterology and Liver Disease, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - Negar Behrouz
- Research Center for Gastroenterology and Liver Disease, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahin Ansari
- Research Center for Gastroenterology and Liver Disease, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Somi
- Research Center for Gastroenterology and Liver Disease, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Shahraz
- Research Center for Gastroenterology and Liver Disease, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Zali
- Research Center for Gastroenterology and Liver Disease, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
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Peshwe HB, Mohandas KM. Hepatitis B control: to vaccinate or not. Indian J Gastroenterol 2004; 23:116-7; author reply 117. [PMID: 15250578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Fagnani F, Le Fur C, Durand I, Gibergy M. Economic evaluation of a combined DTPa, hepatitis B, polio, Hib vaccine. Potential impact of the introduction of Infanrix-Hexa in the French childhood immunisation schedule. Eur J Health Econ 2004; 5:143-149. [PMID: 15452751 DOI: 10.1007/s10198-003-0216-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
A new hexavalent combination vaccine, Infanrix-HEXA, including a recombinant hepatitis B vaccine in addition to the vaccines for diphtheria, tetanus, pertussis, poliomyelitis, and Haemophilus influenzae type B, has recently become available in France. The objectives of this study were to: (1) estimate the break-even price of Infanrix-Hexa for the National Sickness Fund; (2) evaluate its potential impact on vaccine coverage for hepatitis B and the corresponding budget impact. The public price of Infanrix-HEXA associated with a break-even point would be 53.77 euro. Our analyses suggested that other estimates based on a societal perspective including opportunity and indirect costs remained close to this value. The annual additional reimbursed cost of protecting an infant against the risk of hepatitis B would be 28.20 euro per child, or about 21 million euro for an annual cohort of 760,000 births (total cost, 35 million euro). The number of infants protected against hepatitis B could increase from 230,000 in the current situation to about 600,000.
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Affiliation(s)
- Francis Fagnani
- CEMKA, 43 Boulevard Maréchal Joffre, 92340 Bourg-la-Reine, France.
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Wu GY, Gong YL, Yu SL, Shao RT, Qin HJ. [Study on the cost-effectiveness, benefit and utility analysis on the infant inoculation hepatitis B vaccine in Shanghai]. Zhonghua Liu Xing Bing Xue Za Zhi 2004; 25:474-8. [PMID: 15231120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
OBJECTIVE To study the cost-effectiveness, benefit and utility of infant hepatitis B vaccination in Shanghai from 1992 to 2001. METHODS To calculate the cost of hepatitis B vaccination by cost analysis method. Both the numbers of persons with HBsAg positive and patient with hepatitis B, cirrhosis and liver cancer decreased as the index of direct effect. To study the sick-time and the cost of treating hepatitis B, cirrhosis and liver cancer patients, a face to face questionnaire was used and quasi method was adopted to understand the effect of cure and the course of hepatitis B. The cost benefit analysis method was also used to calculate the cost benefit of HBV vaccine. The disability adjusted life years (DALY) was regarded as an index of utility to measure the disease burden. RESULTS Input of 501,129.49 Yuan might have the result of reducing one liver cancer patient, ten cirrhosis patients, one hundred chronic hepatitis B patients and one thousand HBsAg positive people. The cost of hepatitis B vaccination was 0.24 hundred million Yuan during the past ten years in Shanghai, which had obtained the total benefit value of 41.22 hundred million Yuan, with a cost benefit ratio of 1:172 Yuan. It was estimated that the total disease burden of hepatitis B, cirrhosis and liver cancer patients was 59,762.55 DALY in order to reduce one DALY loss cost of 402.50 Yuan. CONCLUSION HBV vaccine inoculation in infants seemed to be a low-cost input and high-effect output strategy.
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Affiliation(s)
- Gui-Ying Wu
- Department of Health Statistics of Social Medicine, School of Public Health, Fudan University, Shanghai 200032, China
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Lack MD. Reducing the Cost of Hepatitis B Vaccination Programs. J Occup Environ Med 2004; 46:418-9. [PMID: 15167387 DOI: 10.1097/01.jom.0000126020.48020.e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Phadke A, Kale A. Hepatitis-B vaccination. J Indian Med Assoc 2004; 102:270. [PMID: 15636033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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