TESTING FOR ANTIBODY TO HEPATITIS-A TO DECREASE THE COST OF HEPATITIS-A PROPHYLAXIS WITH IMMUNE GLOBULIN OR HEPATITIS-A VACCINES

Background: The introduction of new vaccines to prevent hepatitis A in fection raises the question of the cost of these vaccines relative to immune globulin when short-term protection against hepatitis A is requ ired. Since the prevalence of hepatitis A antibodies (anti-HAV) in the US population increases rapidly with age, testing for anti-HAV may de crease the cost of vaccination programs.Methods: A cost-analysis model was developed that incorporates the cost of immune globulin or hepati tis A vaccine, the number of doses of vaccine, the cost of testing for anti-HAV in either commercial or public-sector laboratories, and the prevalence of anti-HAV in the general population by age. Results: In c omparison with hepatitis A vaccines, with expected costs between $10 a nd $25 per dose, use of immune globulin for postexposure prophylaxis o r preexposure shortterm (less than or equal to 6 months) prophylaxis i s much less expensive for all age groups. Testing for anti-HAV does no t significantly diminish the cost of immune globulin regimens. In cont rast, if anti-HAV testing is performed in a public-sector laboratory a t $10 per test, and hepatitis A vaccine costs $10 per dose, testing re duces vaccination costs in those 40 years of age or older for a two-do se vaccine regimen and in those 30 years of age or older for a three-d ose regimen. At the other end of the spectrum, if vaccine costs $35 pe r dose, commercial testing for anti-HAN at $25 per person reduces the costs in those 30 years of age or older if either a two- or three-dose regimen is elected. However, vaccine savings are realized in those 10 years and older if public-sector testing is performed and three doses of vaccine at $35 per dose are utilized. In an intermediate scenario of public-sector testing and vaccines costing $25 per dose, the cost w ould also be reduced in those 30 years old or older. Conclusions: Test ing for anti-HAV in frequent travelers, international government, busi ness, and volunteer workers, military personnel, etc, may be an effect ive means of decreasing costs of hepatitis A prevention.