Cost-Effectiveness of Hepatitis A–B Vaccine Versus Hepatitis B Vaccine for Healthcare and Public Safety Workers in the Western United States

Abstract

AbstractObjective: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.