ABSTRACT
Hepatitis A (HA) vaccination in Canada is currently targeted toward high-risk groups. The cost-effectiveness and expected health outcomes of universal vaccination relative to targeted vaccination in low-incidence countries such as Canada are currently unknown. Here, we conducted a cost-utility analysis for this situation, with Canada as the study population. We included vaccine costs, time costs, infection costs, and public health costs. We assessed a range of possible universal vaccination strategies over an 80-year time horizon using multiple cost perspectives. A dynamic model was used to account for herd immunity. Aggregate health gains from switching to universal vaccination are modest (10-30 QALYs per year). However, a "9+9" strategy that replaces two doses of monovalent hepatitis B (HB) vaccine at 9/10 years (universally administered in most provinces) with two doses of bivalent HA/HB vaccine is cost-saving from the societal perspective. At a willingness to pay threshold of $50,000/QALY, mean net benefit is +49.4 QALYs (S.D. 12.6) from the societal perspective and +3.8 QALYS (S.D. 3.0) from the payer perspective for the "9+9" strategy. Net benefit from the payer perspective is sensitive to the marginal cost of HA/HB vaccine relative to HB vaccine. Similar conclusions may apply in other countries with low incidence and a targeted vaccination policy.
Subject(s)
Hepatitis A Vaccines/economics , Hepatitis A Vaccines/immunology , Hepatitis A/prevention & control , Mass Vaccination/economics , Adolescent , Adult , Age Factors , Aged , Canada/epidemiology , Child , Child, Preschool , Cost-Benefit Analysis , Data Interpretation, Statistical , Female , Hepatitis A/epidemiology , Hepatitis A/mortality , Humans , Immunization Schedule , Infant , Male , Middle Aged , Models, Statistical , Population , Quality-Adjusted Life YearsABSTRACT
Vaccination against Hepatitis A virus (HAV) in Canada is currently targeted toward high-risk groups. However, universal vaccination has been adopted in several other countries with a similar disease burden. Here we develop an age-structured compartmental model of HAV transmission and vaccination in Canada to assess potential universal vaccination strategies. The model predicts that universal vaccination at age 1 (respectively 4, 9, 15), with phasing out of targeted vaccination, would reduce reported incidence by 60% (respectively 52, 36, 31%) and mortality attributable to HAV by 56% (respectively 45, 26, 25%), relative to continued targeted vaccination, over 80 years.
