AN ECONOMIC-EVALUATION OF HEPATITIS-A VACCINATION IN DUTCH MILITARY PERSONNEL

We analyzed the cost-effectiveness of hepatitis A vaccination regimens using a mathematical simulation model. Passive immunization and two a ctive vaccination strategies [with and without prior screening] were c ompared with ''doing nothing.'' Hepatitis A antibodies were determined in 2,325 Dutch marines; other input data were retrieved from publishe d and unpublished sources. The prevalence of hepatitis A antibody was 14%. Screening before vaccination was identified as appropriate at a p revalence > 20%, Passive immunization was the cheapest prevention for a single 6-month deployment per 10 years. The inactivated vaccine cont aining 1,440 enzyme-linked immunosorbent assay units without prior scr eening was identified as the best option for more frequent deployments . It was cost-saving with two or more missions per 10 years. A 5.3% he patitis A attack rate validated the investment for this policy. Overal l, immunization with inactivated hepatitis A vaccine without prior scr eening proved to be the optimum strategy for troops at regular risk.