The cost-effectiveness of hepatitis A vaccination in patients with chronichepatitis C

Infection with hepatitis A virus (HAV) occasionally leads to acute liver fa ilure and has a higher fatality rate in patients with chronic hepatitis C v irus (HCV). Vaccination of patients with HCV against HAV is effective and w ell tolerated. This study examines the cost-effectiveness of HAV vaccinatio n in North American patients with chronic HCV. A decision analysis model wa s constructed to compare 3 HAV vaccination strategies in adult patients wit h chronic HCV over a period of 5 years: (1) vaccinate no patients (treat no ne); (2) vaccinate only susceptible (anti-HAV negative) patients (selective ); or (3) vaccinate all patients without prior testing of immune status (un iversal). Probabilities and direct costs were estimated from hospital data and the literature. The cost per patient for the 3 vaccination strategies w ere: treat none, $2.00; selective, $56.00; and universal, $82.00. For every 1,000,000 patients with HCV vaccinated over a 5-year period, the selective strategy prevented 128 symptomatic cases of HAV 3 liver transplantations, and 3 deaths owing directly to HAV compared with the treat none strategy In addition, the selective strategy costs an additional $427,000 per patient with HAV prevented, and $23 million per HAV-related death averted, compared with the treat none strategy. The results were most sensitive to the incid ence of I HAV infection; vaccination increased costs if the annual rate of infection was less than 0.56% (baseline, 0.01%). Vaccination of North Ameri can patients with chronic HCV against HAV infection is not a cost-effective therapy.