HEPATITIS-B PREVENTION IN EUROPE - A PRELIMINARY ECONOMIC-EVALUATION

The World Health Organization (WHO) estimates that about 350 million p eople in the world are carriers of the hepatitis B virus (HBV), 60 mil lion of whom may die from liver cancer and about 45 million from cirrh osis. In the WHO European Region, which has a total population of 839 million inhabitants, the aver-age number of acute hepatitis B cases re ported in 1991 was approximately 160 000, giving an incidence of 19 pe r 100 000 population. This incidence rate varies from 5 per 100 000 in western Europe to 22 per 100 000 in central Europe and 92 per 100 000 in eastern Europe. Because of under-reporting and the fact that two-t hirds Of infections are asymptomatic, the reported incidence rate cons iderably underestimates the true incidence of HBV in Europe. For this reason, we may multiply the number of reported cases by a factor of 6 (by 2 for under-reporting and by 3 for the symptomatic/asymptomatic ra tio): an estimated 900 000 to 1 000 000 infections of HBV occur in Eur ope each year. Approximately 90 000 chronic infections will develop fr om these new, cases. The spread of HBV can be controlled by universal infant or adolescent vaccination. A decision-tree-based analytical mod el was wed to assess the clinical and economic impact of these two int erventions. The model took into account incidence and prevalence rates of HBV natural history of infection, compliance and effectiveness of vaccination, and direct and indirect costs. Data were obtained from th e literature and from a WHO European survey. The cost-effectiveness ra tio amounts to pound 6443 and pound 4745 per infection prevented for n eonatal and adolescent vaccination, respectively. The results from the se calculations show that neither vaccination of neonates ol of adoles cents is cost-saving. However, the cost-effectiveness - i.e. the cost incurred to prevent an HBV infection is of an acceptable magnitude for both strategies.