Economic evaluations applied to hepatitis B vaccination: general observations

Abstract

Since hepatitis B vaccines became available, there have been many economic evaluations on hepatitis B 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 STD- and IVDU-clinics indicate that risk group vaccination is the most cost-effective strategy to control hepatitis B. In analyses for low endemic countries, recommendations have shifted from risk group vaccination in the eighties to universal vaccination of 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 hepatitis B 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 hepatitis B 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 hepatitis B vaccination and the pressure on resources are highest.