This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

An Economic Analysis of Current Recommendations

Harold S. Margolis, MD; Patrick J. Coleman, PhD; Ruth E. Brown, MS; Eric E. Mast, MD; Steven H. Sheingold, PhD; Jose A. Arevalo, MD

JAMA. 1995;274(15):1201-1208.

Abstract
Objective.
—To evaluate the outcome of immunization strategies to prevent hepatitis B virus (HBV) transmission.

Design and Setting.
—A decision model was used to determine the incremental effects of the following hepatitis B immunization strategies in a birth cohort receiving immunization services in the public sector: (1) prevention of perinatal HBV infection, (2) routine infant vaccination, or (3) routine adolescent vaccination.

Main Outcome Measures.
—Over the lifetime of the cohort, the reduction in infections and medical and work-loss costs of HBV-related liver disease were determined for each strategy and compared with the outcome without immunization.

Results.
—Prevention of perinatal infection and routine infant vaccination would lower the 4.8% lifetime risk of HBV infection by at least 68%, compared with a 45% reduction for adolescent vaccination. From a societal perspective, each strategy was found to be cost saving, but was not cost saving with respect to direct medical costs. The estimated cost per year of life saved was $164 to prevent perinatal HBV infection, $1522 for infant vaccination, and $3730 for adolescent vaccination.

Conclusions.
—Routine vaccination of infants in successive birth cohorts to prevent HBV transmission is cost-effective over a wide range of assumptions. While economically less attractive than infant vaccination, adolescent vaccination could serve to protect those children who were not vaccinated as infants.

(JAMA. 1995;274:1201-1208)

Author Affiliations
From the Hepatitis Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga (Drs Margolis, Coleman, and Mast); Battelle Human Affairs Research Center, Washington, DC (Ms Brown); Office of Technology and Special Analysis, Bureau of Policy Development, Health Care Financing Administration, Washington, DC (Dr Sheingold); and Planned Parenthood of Sacramento Valley, Sacramento, Calif (Dr Arevalo).

Footnotes
Reprint requests to Hepatitis Branch (A-33), Centers for Disease Control and Prevention, Atlanta, GA 30333 (Dr Margolis).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Community transmission of hepatitis B virus in Egypt: results from a case-control study in Greater Cairo
Jimenez et al.
Int J Epidemiol 2009;38:757-765.
ABSTRACT | FULL TEXT  

Measuring the Value of Public Health Systems: The Disconnect Between Health Economists and Public Health Practitioners
Neumann et al.
AJPH 2008;98:2173-2180.
ABSTRACT | FULL TEXT  

Cost effectiveness of hepatitis B vaccination strategies in Ireland: an economic evaluation
Tilson et al.
Eur J Public Health 2008;18:275-282.
ABSTRACT | FULL TEXT  

New, and Some Not-so-New, Vaccines for Adolescents and Diseases They Prevent
Fishbein et al.
Pediatrics 2008;121:S5-S14.
ABSTRACT | FULL TEXT  

Vaccinating Adolescents in High-Risk Settings: Lessons Learned From Experiences With Hepatitis B Vaccine
Sneller et al.
Pediatrics 2008;121:S55-S62.
ABSTRACT | FULL TEXT  

Projected Cost-effectiveness of New Vaccines for Adolescents in the United States
Ortega-Sanchez et al.
Pediatrics 2008;121:S63-S78.
ABSTRACT | FULL TEXT  

Cost-Effectiveness of Screening and Vaccinating Asian and Pacific Islander Adults for Hepatitis B
Hutton et al.
ANN INTERN MED 2007;147:460-469.
ABSTRACT | FULL TEXT  

Cost-effectiveness and Potential Impact of Rotavirus Vaccination in the United States
Widdowson et al.
Pediatrics 2007;119:684-697.
ABSTRACT | FULL TEXT  

Bicistronic Woodchuck Hepatitis Virus Core and Gamma Interferon DNA Vaccine Can Protect from Hepatitis but Does Not Elicit Sterilizing Antiviral Immunity
Wang et al.
J. Virol. 2007;81:903-916.
ABSTRACT | FULL TEXT  

Cost-Effectiveness of Routine Childhood Vaccination for Hepatitis A in the United States
Rein et al.
Pediatrics 2007;119:e12-e21.
ABSTRACT | FULL TEXT  

Single-dose and multiple-dose pharmacokinetics and safety of telbivudine after oral administration in healthy chinese subjects.
Hu et al.
J Clin Pharmacol 2006;46:999-1007.
ABSTRACT | FULL TEXT  

Effect of hepatitis B immunisation in newborn infants of mothers positive for hepatitis B surface antigen: systematic review and meta-analysis
Lee et al.
BMJ 2006;332:328-336.
ABSTRACT | FULL TEXT  

Economic Evaluation of the 7-Vaccine Routine Childhood Immunization Schedule in the United States, 2001
Zhou et al.
Arch Pediatr Adolesc Med 2005;159:1136-1144.
ABSTRACT | FULL TEXT  

A mathematical model to estimate global hepatitis B disease burden and vaccination impact
Goldstein et al.
Int J Epidemiol 2005;34:1329-1339.
ABSTRACT | FULL TEXT  

Cost-Effectiveness of Conjugate Meningococcal Vaccination Strategies in the United States
Shepard et al.
Pediatrics 2005;115:1220-1232.
ABSTRACT | FULL TEXT  

A Middle School Immunization Law Rapidly and Substantially Increases Immunization Coverage Among Adolescents
Averhoff et al.
AJPH 2004;94:978-984.
ABSTRACT | FULL TEXT  

Impact of Thimerosal-Related Changes in Hepatitis B Vaccine Birth-Dose Recommendations on Childhood Vaccination Coverage
Luman et al.
JAMA 2004;291:2351-2358.
ABSTRACT | FULL TEXT  

The Business Case for Quality: Combining Medical Literature Research with Health Plan Data to Establish Value for Nonclinical Managers
Fetterolf and West
American Journal of Medical Quality 2004;19:48-55.
ABSTRACT  

HEPATITIS B INFECTION IN RURAL VIETNAM AND THE IMPLICATIONS FOR A NATIONAL PROGRAM OF INFANT IMMUNIZATION
HIPGRAVE et al.
Am J Trop Med Hyg 2003;69:288-294.
ABSTRACT | FULL TEXT  

Successful Promotion of Hepatitis B Vaccinations Among Vietnamese-American Children Ages 3 to 18: Results of a Controlled Trial
McPhee et al.
Pediatrics 2003;111:1278-1288.
ABSTRACT | FULL TEXT  

Economic Analysis of Promotion of Hepatitis B Vaccinations Among Vietnamese-American Children and Adolescents in Houston and Dallas
Zhou et al.
Pediatrics 2003;111:1289-1296.
ABSTRACT | FULL TEXT  

Hepatitis B Surface Antigen Prevalence Among Pregnant Women in Urban Areas: Implications for Testing, Reporting, and Preventing Perinatal Transmission
Euler et al.
Pediatrics 2003;111:1192-1197.
ABSTRACT | FULL TEXT  

Cost-Effectiveness Analysis of Predischarge Monitoring for Apnea of Prematurity
Zupancic et al.
Pediatrics 2003;111:146-152.
ABSTRACT | FULL TEXT  

Outcomes Research in Pediatric Settings: Recent Trends and Future Directions
Forrest et al.
Pediatrics 2003;111:171-178.
ABSTRACT | FULL TEXT  

Childhood Hepatitis B Virus Infections in the United States Before Hepatitis B Immunization
Armstrong et al.
Pediatrics 2001;108:1123-1128.
ABSTRACT | FULL TEXT  

Economic Analysis of a Child Vaccination Project Among Asian Americans in Philadelphia, Pa
Deuson et al.
Arch Pediatr Adolesc Med 2001;155:909-914.
ABSTRACT | FULL TEXT  

Correlates of Vaccination for Hepatitis B Among Adolescents: Results From a Parent Survey
Seid et al.
Arch Pediatr Adolesc Med 2001;155:921-926.
ABSTRACT | FULL TEXT  

Economic Evaluation of a 2-Dose Hepatitis B Vaccination Regimen for Adolescents
Levaux et al.
Pediatrics 2001;108:317-325.
ABSTRACT | FULL TEXT  

Annual Report to the Nation on the Status of Cancer (1973 Through 1998), Featuring Cancers With Recent Increasing Trends
Howe et al.
JNCI J Natl Cancer Inst 2001;93:824-842.
ABSTRACT | FULL TEXT  

Hepatitis B Immunization Coverage Among Vietnamese-American Children 3 to 18 Years Old
Jenkins et al.
Pediatrics 2000;106:78e-78.
ABSTRACT | FULL TEXT  

The Cost-effectiveness of Adolescent Hepatitis A Vaccination in States With the Highest Disease Rates
Jacobs et al.
Arch Pediatr Adolesc Med 2000;154:763-770.
ABSTRACT | FULL TEXT  

Projected Cost-effectiveness of Pneumococcal Conjugate Vaccination of Healthy Infants and Young Children
Lieu et al.
JAMA 2000;283:1460-1468.
ABSTRACT | FULL TEXT  

Recommendations Regarding the Use of Vaccines That Contain Thimerosal as a Preservative
JAMA 1999;282:2114-2115.
FULL TEXT  

Availability of Hepatitis B Vaccine That Does Not Contain Thimerosal as a Preservative
JAMA 1999;282:1219-1220.
FULL TEXT  

Update on Diagnosis, Management, and Prevention of Hepatitis B Virus Infection
Mahoney
Clin. Microbiol. Rev. 1999;12:351-366.
ABSTRACT | FULL TEXT  

Clinical and Economic Impact of a Combination Haemophilus influenzae and Hepatitis B Vaccine: Estimating Cost-effectiveness Using Decision Analysis
Fendrick et al.
Arch Pediatr Adolesc Med 1999;153:126-136.
ABSTRACT | FULL TEXT  

Cost-effectiveness Analysis of a Rotavirus Immunization Program for the United States
Tucker et al.
JAMA 1998;279:1371-1376.
ABSTRACT | FULL TEXT  

Hepatitis B Immunization in a Low-incidence Province of Canada: Comparing Alternative Strategies
Wiebe et al.
Med Decis Making 1997;17:472-482.
ABSTRACT  

Newborn Hepatitis B Immunization Rates in Primary Care Practices
Bertolino
Arch Pediatr Adolesc Med 1996;150:1173-1176.
ABSTRACT  

Cost-effectiveness of Hepatitis B Virus Immunization
Edmunds et al.
JAMA 1996;275:907-907.
ABSTRACT  

Cost-effectiveness of Hepatitis B Virus Immunization
Everett
JAMA 1996;275:908-908.
ABSTRACT  

Cost-effectiveness of Hepatitis B Virus Immunization
Watters and Kral
JAMA 1996;275:907-908.
ABSTRACT  

Cost-effectiveness of Hepatitis B Virus Immunization
Sharfstein and Wise
JAMA 1996;275:908-908.
ABSTRACT  

The Case for Early, Comprehensive Hepatitis B Immunization
Journal Watch Dermatology 1995;1995:17-17.
FULL TEXT  

THE CASE FOR EARLY, COMPREHENSIVE HEPATITIS B IMMUNIZATION
JWatch General 1995;1995:3-3.
FULL TEXT  

The Public's Health Unprotected: Reversing a Decade of Underutilization of Hepatitis B Vaccine
Francis
JAMA 1995;274:1242-1243.
ABSTRACT