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The Economics of Hepatitis B Virus Vaccination

An Analysis of Cost-Effectiveness Results for Switzerland

  • Original Research Article
  • Published:
Disease Management and Health Outcomes

Abstract

Objective: To assess and compare the costs and effectiveness of different vaccination strategies against hepatitis B in Switzerland.

Design: A birth cohort of 85 000 individuals was followed over their lifetime, using a decision-tree analysis. Published data were used to simulate the risk of hepatitis B virus (HBV) infection in the cohort, the consecutive clinical outcomes and the associated costs. Five new vaccination scenarios were assessed and compared with a baseline strategy of vaccination of high-risk groups. The 5 new vaccination scenarios were: (i) systematic prenatal screening and vaccination of newborns at risk; (ii) universal vaccination of infants; (iii) universal vaccination of school children; (iv) universal vaccination of infants and school children; and (v) universal vaccination of infants, school children and adolescents.

Results: The incremental cost per year of life saved for systematic prenatal screening and vaccination of newborns at risk compared with the baseline scenario was estimated to be 23 350 Swiss francs (SwF; 1996 values). The 4 universal vaccination scenarios had a much larger impact on the number of chronic infections and deaths prevented. The incremental cost per year of life saved for universal vaccination compared with systematic prenatal screening and vaccination of newborns at risk ranged from SwF6120 (infant vaccination strategy) to SwF10 200 (school children vaccination strategy). In the sensitivity analysis, prevalence, vaccine price and discount rate were key elements.

Conclusions: Incremental cost-effectiveness ratios are lower with universal vaccination strategies than with selective vaccination. Furthermore, with universal vaccination strategies, increasingly ambitious strategies result in higher costs but also in more incremental years of life saved.

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Notes

  1. In order to avoid a complex tree, square nodes which denote choice nodes were omitted.

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Acknowledgements

This study was commissioned by the Swiss Federal Office of Public Health. Many thanks are due to the members of a special expert panel established to advise on data collection and the estimation of various parameters. The members were: Dr P. Coleman, Centers for Disease Control, Atlanta, USA; Dr J. Edmunds, Warwick University, England; Prof. P. Grob, Zurich University Hospital, Switzerland; Prof. P. Francioli, Division Autonome de Médecine Préventive Hospitalière, CHUV, Lausanne, Switzerland; Dr D. Lavanchy, World Health Organization, Geneva, Switzerland; Prof. F. Paccaud, Institut Universitaire de Médecine Sociale et Préventive, Lausanne, Switzerland; Dr M. Rickenbach, Institut Universitaire de Médecine Sociale et Préventive, Lausanne, Switzerland. We also acknowledge the useful comments and suggestions by 2 anonymous referees. The views expressed in this paper are solely the responsibility of the authors. The paper does not represent an official view of the World Health Organization.

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Authors and Affiliations

  1. University of Lausanne, Lausanne, Switzerland

    Pascal Zurn (Research Fellow) & Jean-Pierre Danthine (Professor of Economics)

  2. World Health Organization, Geneva, Switzerland

    Guy Carrin (Senior Health Economist) & Mark Kane (Director)

  3. Swiss Federal Office of Public Health, Bern, Switzerland

    Raoul Kammerlander (Scientific Advisor)

  4. Children’s Vaccine Programme, Bill & Melinda Gates Foundation, Seattle, USA

    Mark Kane (Director)

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  1. Pascal Zurn
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  2. Guy Carrin
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  3. Jean-Pierre Danthine
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  4. Raoul Kammerlander
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  5. Mark Kane
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Correspondence to Pascal Zurn.

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Zurn, P., Carrin, G., Danthine, JP. et al. The Economics of Hepatitis B Virus Vaccination. Dis-Manage-Health-Outcomes 7, 331–347 (2000). https://doi.org/10.2165/00115677-200007060-00004

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