HEPATITIS-B VACCINATION THE COST-EFFECTIVENESS OF ALTERNATIVE STRATEGIES IN ENGLAND AND WALES

Objective - To assess the cost effectiveness of adding universal hepatitis B vaccination in infancy or pre-adolescence to a policy of selective vaccination of at risk groups. Design - Costs of a selective policy anti additional costs of universal vaccination policies were estimated from costs of vaccine delivery and published data on target populations. Additional years of life gained were calculated for each policy by applying life tables to estimates of mortality attributable to hepatitis B. Setting - England and Wales. Results - Compared with no vaccination, vaccination in infancy was the most cost effective followed by vaccination in preadolescence. Selective vaccination was the least effective (cost per year of life gained pound 2568, pound 2824, and pound 8564 respectively). Adding vaccination in infancy or at pre-adolescence to a selective policy cost pound 1537 or pound 1658 per year of life gained. Discounting years gained in the future at 6% per annum, however, made pre-adolescent vaccination more cost effective than infant or selective vaccination (pound 51 817, pound 94 821, and pound 124 779 per discounted year of life gained). Adding pre-adolescent vaccination to a selective policy cost pound 32 125 per discounted year of life gained and infant vaccination, pound 77 085. Conclusions - Universal vaccination against hepatitis B was more cost effective than selective vaccination in a low prevalence country. Discounting future health gain, however, made universal infant vaccination lest cost effective than universal pre-adolescent vaccination. If future health gained is as important as present gain the addition of universal vaccination to a selective policy is equivalent to the cost per quality adjusted year of life from renal transplantation or breast cancer screening.