SHOULD BRITISH SOLDIERS BE VACCINATED AGAINST HEPATITIS-A - AN ECONOMIC-ANALYSIS

We conducted a study to analyse the efficiency of introducing vaccinat ion against hepatitis A to the schedule for tl oops in the British Arm y. The study design included a cost-effectiveness analysis (CEA) of co st per case avoided comparing active and passive immunization and a co st-benefit analysis (CBA). The study population comprised all British Army personnel as well as those soldiers assumed to be deployed to hig h-risk areas a variable number of times in 5 years. The average cost o f one case of hepatitis A avoided by vaccination was calculated and co mpared with the average cost of achieving the same outcome by passive immunization. In a 5-year four-exposure scenario at a low incidence an d using a 3% discount race, avoiding One case of hepatitis A by Vaccin ation would cost pound 52865, against pound 97305 by passive immunizat ion. The equivalent cost-benefit ratios are 13.4 for gammaglobulin and 7.2 for vaccine. For fewer exposures the break-even point for vaccine is two exposures in 4 years. Although our estimates are sensitive to direct costs and relatively sensitive to the estimated incidence, vacc inating troops against hepatitis A appears to be a more efficient proc edure than passive immunization, especially as a long-term investment in troops likely to effect several operational deployments. Given the difficulty, of forecasting which troops would deploy, the best-buy str ategy may be vaccination of troops most likely to deploy repeatedly.