COST-EFFECTIVENESS OF HEPATITIS-A VACCINATION IN HEALTH-CARE WORKERS

OBJECTIVE: To study the cost-effectiveness of vaccination for hepatiti s A. SETTING: Hypothetical analysis of students currently enrolled in medical school in the United States. METHOD: A Markov-based model was developed using data som the literature, actual hospital costs, and an annual discount rate of 5%. The incidence rate: was based on the lowe st annual rate for the US population during the past decade. RESULTS: Over the lifetimes of students currently in medical school, the model estimated that there would be 286 hepatitis A cases with four deaths a nd 107 lost years of life. With routine vaccination, these numbers wou ld decrease to 17, 0.3, and 6, respectively, The costs per life-year s aved and quality adjusted life-year saved were $58,000 and $47,000, re spectively. Serologic screening prior to vaccination was less cost-eff ective than universal vaccination. if the incidence of hepatitis A was underestimated by a factor of 5, the cast per life-year saved would d ecrease to $5,500. If the incidence of hepatitis was underestimated by a factor of 10, vaccination would result in a net cost savings. CONCL USION: We conclude that the cost per life-year saved by routine hepati tis A vaccination was similar to many other standard medical modalitie s. For routine vaccination of medical students to be cost-saving, the incidence rate for hepatitis A must be at least 10 times higher than t he rate presently reported for the general population. Serological scr eening prior to vaccination was not cost-effective.