COST-EFFECTIVENESS ANALYSIS OF VACCINATION AGAINST HEPATITIS-A IN TRAVELERS

Hepatitis A virus (HAV) infection is a substantial risk for travellers from low endemic countries to high endemic destinations. Costs and ef fects of alternative options for prevention were compared using formal decision analysis. General indications for the optimal prevention of hepatitis A were derived from a cost-effectiveness analysis. Various p ossible strategies for prevention of hepatitis A in travellers were co mpared to doing nothing: active immunisation using either the existing vaccine (HAVR1X 720) or the new vaccine (HAVRIX(TM) 1440); first scre ening for the presence of HAV antibodies and then vaccinating only sus ceptibles; and passive immunisation with immunoglobulin. Using a numbe r of assumptions as baseline and for an average duration and frequency of travel from low to high endemic countries, threshold values were o btained for the choice between passive and active immunisation. Passiv e immunisation remains the most cost-effective prevention strategy for those expected to travel not more frequently than twice over the next 10 years and for short stays (pound 7,000-9,000 per infection prevent ed). For travellers expected to travel three or more times in 10 years or for trips exceeding a period of 6 months, active immunisation befo re the first trip is the most cost-effective option (pound 7,500 or le ss per infection prevented). When travel frequency increases to once a year in the next 10 years, costs per infection prevented decrease to about pound 3,500. Screening for the presence of antibodies before vac cination is only justified for older travellers or those leaving from countries with moderate endemicity, i.e., with an average HAV prevalen ce of at least 30%. (C) 1994 Wiley-Liss, Inc.