Economic evaluations applied to HB vaccination: general observations

Since HE vaccines became available, there have been many economic evaluations on HE vaccination programs. The majority of them were for countries of low endemicity. Economic evaluations for countries of very low endemicity with a good surveillance system in place and high attendance of Sexually Transmitted Disease- and IntraVenous Drug Users-clinics indicate that risk group vaccination is the most cost-effective strategy to control HB. In analyses for low endemic countries, recommendations have shifted from risk group vaccination In the eighties to universal vaccination or either infants or adolescents in the nineties. For the health care payer, the resulting cost-effectiveness ratios of universal vaccination were Favourable in comparison to those of other preventive interventions. From a societal point of view, universal HE vaccination was found to be cost-saving in these countries. Few published studies were set in countries of intermediate to high endemicity. They indicate that for the health care payer universal HE vaccination of neonates or infants is cost-effective compared to other interventions, or even cost-saving. Further studies are needed to support decision making in high endemic countries, where both the need for HE vaccination and the pressure on resources are highest. (C) 1998 Elsevier Science Ltd. All rights reserved.