Public Acceptance and Willingness to Hepatitis A Vaccination in Children Aged 7-18 Years in Republic of Korea

Hepatitis A can cause serious illness among adolescents and adults with low vaccination coverage. Even though hepatitis A vaccine is one of the strong candidates for Korean national immunization program, adolescents aged older than 12 yr would not benefit. Our purpose was to assess the willingness and analyze the correlates of Korean mothers for hepatitis A (HepA) vaccination to develop strategies for HepA vaccination. A national telephone survey on 800 mothers with children aged 7-18 yr was conducted with random-digit dialing method. Sixty-two percent and 92% of the mothers reported that they were willing to HepA vaccination at current cost and at half of the current cost, respectively. However, at current cost, only 79% wished to vaccinate their child in an epidemic and 32% wished to vaccinate promptly. Having two or more children, not having future plans to send the child overseas, and low family income were significantly associated with not willing to HepA vaccination. Low perception of the susceptibility for hepatitis A and perception of the current cost as barrier increased the odds of unwillingness to vaccination at current cost and to prompt vaccination. The mothers' willingness to HepA vaccination for the children aged 7-18 yr in Korea was not very high at current cost and associated socioeconomic status and health-belief. Targeted intervention or strategies are needed to increase the HepA vaccination rate among children in Korea.

Contributions from the systematic review of economic evaluations: the case of childhood hepatitis A vaccination in Brazil / Contribuições da revisão sistemática de avaliações econômicas: o exemplo da vacinação infantil contra hepatite A no Brasil

The aim of this study was to present the contributions of the systematic review of economic evaluations to the development of a national study on childhood hepatitis A vaccination. A literature review was performed in EMBASE, MEDLINE, WOPEC, HealthSTAR, SciELO and LILACS from 1995 to 2010. Most of the studies (8 of 10) showed favorable cost-effectiveness results. Sensitivity analysis indicated that the most important parameters for the results were cost of the vaccine, hepatitis A incidence, and medical costs of the disease. Variability was observed in methodological characteristics and estimates of key variables among the 10 studies reviewed. It is not possible to generalize results or transfer epidemiological estimates of resource utilization and costs associated with hepatitis A to the local context. Systematic review of economic evaluation studies of hepatitis A vaccine demonstrated the need for a national analysis and provided input for the development of a new decision-making model for Brazil.

O objetivo deste estudo foi apresentar as contribuições da revisão sistemática de avaliações econômicas para o desenvolvimento de um estudo nacional, o caso da vacinação infantil contra hepatite A. Foi realizada revisão da literatura nas bases de dados EMBASE, MEDLINE, WOPEC, HealthSTAR, SciELO e LILACS, no período de 1995 a 2010. A maioria dos estudos (8 em 10) mostrou resultados favoráveis de custo-efetividade. As análises de sensibilidade indicaram como parâmetros mais importantes para os resultados os custos da vacina, incidência de hepatite A e custos médicos da doença. Foi observada variabilidade nas características metodológicas e estimativas de variáveis-chaves dos 10 estudos revisados. Não é possível generalização dos resultados e transferibilidade de estimativas epidemiológicas, de usos de recursos e custos associados à hepatite A para o contexto local. A revisão sistemática dos estudos de avaliação econômica da vacina contra hepatite A demonstrou a necessidade de uma análise nacional e forneceu elementos para o desenvolvimento de um novo modelo de decisão para o Brasil.

Hepatitis A: the costs and benefits of the disease prevention by vaccine, Paraná, Brazil

This study evaluated the epidemiological behavior of the hepatitis A in Paraná state and compared the costs of the disease and the vaccination. This is an epidemiological descriptive study including a pharmacoeconomy analysis. We collected information in the national database reported cases (SINAN), in the mortality information system (SIM) and in the hospital information system (AIH) among 2000/2003 (Paraná State Public Health Department). We estimated the probability of one cohort of children to acquire hepatitis A during their lifetime and the costs with their treatment. We compared those costs with the cost of vaccinating the children. 14,682 hepatitis A cases were registered during the period studied, and 12,102 (82.4 percent) occurred in the 0-15 years-old age group. The annual incidence in the general population was 37.5/100,000. We observed 20 deaths caused by this disease; 7 of those occurred by liver failure. The estimated costs with the disease included the hospital costs, liver transplantation, liver failure treatment, and laboratory tests were high. The price of the vaccine is 10 USD/dose. Two doses are necessary to get the protection. The results showed a positive cost - benefit relation when we vaccinate children. We save 2.26 USD in treatment for each dollar invested in the vaccine. Paraná record high number of hepatitis A cases each year. We confirmed the positive cost - benefit relation when we vaccinate children against hepatitis A, reducing suffering, hospitalization, death and social costs. Vaccination against hepatitis A should be recommended in the routine of immunization program in Paraná state.

Universal vaccination of children against hepatitis a in Chile: a cost-effectiveness study / La vacunación infantil universal contra la hepatitis a en Chile: análisis de la relación costo-efectividad

OBJECTIVE: To evaluate the healthcare and economic impact of routine hepatitis A vaccination of toddlers in Chile. METHODS: We used a dynamic model of hepatitis A infection to evaluate the impact of a two-dose vaccination program, administered at ages 12 and 18 months. The model incorporated the changing epidemiology of hepatitis A in Chile and the development of vaccine-induced herd immunity. Our analysis was conducted from the public payer perspective, and an estimation of the societal perspective was performed. Costs are expressed in 2005 U.S. dollars. RESULTS: Vaccination of toddlers rapidly reduced the healthcare burden of hepatitis A. In the base case (95 percent vaccination coverage, 100-year time horizon, 1 percent annual decrease in force of infection), the average number of infections fell by 76.6 percent annually, and associated deaths fell by 59.7 percent. Even at 50 percent coverage, the program reduced infection rates substantially. Routine vaccination of toddlers had economic as well as health benefits, saving $4 984 per life-year gained (base case scenario). The program became cost saving after 6 years, and its overall cost-effectiveness per life-year gained was largely unaffected by changes in disease-related costs, herd immunity, coverage rate, and annual decrease in force of infection. CONCLUSIONS: Routine vaccination of toddlers will reduce the rates of symptomatic hepatitis A and associated mortality. The two-dose schedule evaluated here will be less expensive than disease-related costs in the absence of vaccination from the sixth year of its implementation. These findings support the establishment of a routine vaccination program for toddlers in Chile.

OBJETIVO: Evaluar el impacto sanitario y económico de la vacunación sistemática de infantes contra la hepatitis A en Chile. MÉTODOS: Se empleó un modelo dinámico de hepatitis A para evaluar el impacto de un programa de vacunación de dos dosis administradas a los 12 y 18 meses. El modelo incorporó la epidemiología cambiante de la hepatitis A en Chile y la aparición de la inmunidad de grupo inducida por la vacuna. El análisis se realizó desde la perspectiva del financiador público y se hizo un estimado desde la perspectiva de la sociedad. Los costos se expresaron en dólares estadounidenses del año 2005. RESULTADOS: La vacunación de los infantes redujo rápidamente la carga de la hepatitis A para los servicios de salud. En la variante de base (cobertura de la vacunación: 95 por ciento; horizonte temporal: 100 años; reducción anual de la virulencia de la infección: 1 por ciento), el número promedio de casos se redujo anualmente en 76 por ciento y el número de muertes asociadas disminuyó en 59,7 por ciento. Incluso con una cobertura de vacunación de 50 por ciento, el programa redujo notablemente la tasa de infección. La vacunación sistemática de los infantes presentó beneficios económicos y sanitarios y ahorró US$ 4 984,00 por año de vida ganado (en el escenario base). El programa generó ahorros a partir del sexto año y la efectividad general en función del costo por año de vida ganado no se afectó por cambios en los costos relacionados con la enfermedad, la inmunidad de grupo, la cobertura de vacunación o la reducción anual de la virulencia de la infección. CONCLUSIONES: La vacunación sistemática de los infantes reduciría la tasa de hepatitis A sintomática y la mortalidad asociada. A partir del sexto año del programa, los costos de aplicar el esquema evaluado de dos dosis serían menores que los relacionados con la enfermedad si no se aplicara la vacuna. Estos resultados apoyan la implantación de programas de vacunación sistemática de infantes...

Cost-effectiveness of childhood hepatitis A vaccination in Argentina: a second dose is warranted

OBJECTIVES: To investigate the cost-effectiveness of childhood vaccination against hepatitis A in the five geographic regions of Argentina, and to determine whether adding a second dose to the current one-dose schedule would provide health gains justifying its added cost. METHODS: A Markov model was used to consider four immunization options for the 2005 birth cohort: (1) no vaccination; (2) vaccination at 12 months of age, (3) vaccinations at 12 and 72 months of age; or (4) vaccinations at 12 and 18 months of age. Hepatitis A costs and consequences were predicted over 50 years. The cost-effectiveness of first and second vaccine doses was assessed through a range of vaccine prices and assumptions regarding the duration of vaccine protection. Costs and health gains (measured in quality-adjusted life years) were adjusted to present values using a 3 percent annual discount rate. RESULTS: The one-dose vaccination policy is predicted to reduce each birth cohort member's 50-year probability of overt hepatitis A from 7.2 percent to 4.1 percent. A second dose would reduce the probability to between 2.0 percent and 2.2 percent. Vaccination at 12 months of age, at 12 and 72 months, or at 12 and 18 months would reduce cases among personal contacts by 82 percent, 87 percent, and 92 percent, respectively. The first vaccine dose would meet accepted standards of cost-effectiveness in each region, and reduce costs in the Northeast, Central, and South regions. Adding a second dose at age 18 months would be cost-effective in each region, and further reduce costs in the Cuyo region. If the duration of protection with one dose is less than anticipated, the second dose would be more cost-effective. CONCLUSIONS: Greater health gains are derived from the first than second hepatitis A vaccine dose. However, this analysis supports the cost-effectiveness of providing both first and second doses to Argentina's children.

OBJETIVOS: Investigar la efectividad en función del costo de la vacunación infantil contra la hepatitis A en las cinco regiones de Argentina y determinar si la adición de una segunda dosis al esquema actual de una dosis aumentaría los beneficios a la salud y si estos justificarían el costo adicional. MÉTODOS: Se empleó el modelo de Markov para valorar cuatro opciones de vacunación para la cohorte nacida en el año 2005: 1) no vacunar; 2) vacunar a los 12 meses de edad; 3) vacunar a los 12 y a los 72 meses; y 4) vacunar a los 12 y a los 18 meses de edad. Se estimaron el costo y las consecuencias de la enfermedad a 50 años. La efectividad en función del costo de la primera y la segunda dosis de la vacuna se calculó a partir de varios precios de la vacuna e hipótesis acerca de la duración de la protección. Los costos y los beneficios para la salud (medidos en años de vida ajustados por la calidad de vida) se ajustaron por los valores actuales utilizando una tasa de descuento anual de 3 por ciento. RESULTADOS: Se estima que la política de vacunación con una dosis reduciría la probabilidad de cada miembro de la cohorte de padecer hepatitis A sintomática en 50 años de 7,2 por ciento a 4,1 por ciento. Una segunda dosis reduciría esa probabilidad a 2,0 por ciento-2,2 por ciento. La vacunación a los 12 meses de edad, a los 12 y a los 72 meses, o a los 12 y a los 18 meses reduciría el número de casos entre los contactos personales en 82 por ciento, 87 por ciento y 92 por ciento, respectivamente. La primera dosis de la vacuna satisfaría los estándares aceptados de efectividad en función del costo en todas las regiones del país y reduciría los costos en las regiones Nordeste, Central y Sur. La aplicación de una segunda dosis a los 18 meses resultaría efectiva en función del costo en todas las regiones y reduciría adicionalmente los costos en la región de Cuyo. Si la duración de la protección con una dosis fuera menor de la esperada, la segunda dosis...

Hepatitis A vaccination in chronic liver disease: is it really required in a tropical country like India?

Vaccination against hepatitis A virus (HAV) has been recommended in patients with chronic liver disease to prevent any decompensation due to superinfection. This may not hold good in high endemic areas for hepatitis A like India. The aim of this study was to find out the seroprevalence of anti-HAV antibodies in patients with chronic liver disease and to justify the need for vaccination against hepatitis A virus in these patients. One hundred and thirty three consecutive patients with cirrhosis of liver attending Gastroenterology department of our Institute between June 2004 and June 2005 were enrolled. Seventy-five healthy persons were taken as controls. The diagnosis of cirrhosis was based on clinical profile, biochemical, radiological (ultrasound abdomen) and endoscopic findings. The etiology of cirrhosis was based on presence of viral markers, history of significant alcohol consumption, autoimmune and metabolic workup. All patients and controls were tested for antiHAV (total) antibodies using commercially available enzyme-linked immunosorbent assay kits. Data from patients and control group were compared by unpaired 't' test and Chi square test. All subjects were in the age group 11 to 75 years. Etiology of chronic liver disease was as follows: HBV- 29.3%, HCV - 14.28%, HBV+HCV dual -1.5%, alcohol- 21.8%, Cryptogenic -23.3%, Wilson"s Disease -1.5% and Budd chiari -1.5%. The prevalence of HAV was 93.2% in patients with cirrhosis of liver and 94.6% in controls. The prevalence was almost similar irrespective of the etiology. In view of high seroprevalence of HAV antibodies among cirrhotic patients in our study and the high cost of the vaccine, the hepatitis A vaccination may not be routinely required in this part of the world.