A COST-EFFECTIVENESS ANALYSIS OF PREVACCINATION TESTING FOR HEPATITIS-B IN ADOLESCENTS AND PREADOLESCENTS

Objective: To study the clinical effectiveness and cost-effectiveness of prevaccination testing for hepatitis B virus in adolescents and pre adolescents. Design: Decision analysis model comparing (1) prevaccinat ion testing for hepatitis B surface antibodies, (2) no testing, and (3 ) testing at the same time as the first vaccine dose. Sensitivity anal yses of the first two strategies were performed varying the seropreval ence of hepatitis B surface antibodies, compliance with follow-up, and costs of testing. Setting: Charges for testing and vaccination were o btained from Children's Hospital and Medical Center in Seattle, Wash. Vaccination compliance, hepatitis B surface antibodies seroprevalence, and vaccine response rates are from published literature. Patients: A hypothetical cohort of 100 000 11-year-old children presenting for we ll-child care. Main Outcome Measures: Rate of complete vaccination, co st of testing and vaccination for each cohort, and cost per patient pr otected from hepatitis B virus.Results: No testing was the most cost-e ffective strategy. Prevaccination testing elevated costs by $2.9 milli on for every 100 000 patients and lowered the rate of complete vaccina tion by 22% compared with vaccination without testing. For prevaccinat ion testing to be cost-effective, the seroprevalence of hepatitis B su rface antibodies needed to be greater than 40%. As the seroprevalence of hepatitis B surface antibodies decreased, the ratio of testing cost s to vaccination costs had to decrease for prevaccination testing to r emain cost-effective. Even with perfect compliance, prevaccination tes ting required high seroprevalence rates to be cost-effective. Conclusi ons: For most populations of preadolescents and adolescents, prevaccin ation testing for hepatitis B virus is not effective in terms of cost or rate of complete vaccination.