Cost effectiveness of vaccinating food service workers against hepatitis Ainfection

Foodborne transmission is an important means of hepatitis A infection that may be reduced through vaccination of food service workers (FSWs). Several states are considering actions to encourage or mandate FSW vaccination, bur the cost effectiveness of such policies has not been assessed. We estimate d the clinical and economic consequences of vaccinating FSWs from the 10 st ates with the highest reported rates of hepatitis A. A decision analytic mo del was used to predict the effects of vaccinating FSWs at age 20 years. It was assumed all FSWs would receive one dose of inactivated hepatitis A vac cine, and 50% would receive the second recommended dose. Parameter estimate s were obtained from published reports and Centers for Disease Control and Prevention databases. The primary endpoint was cost per year of life saved (YOLS). Secondary endpoints were symptomatic infections, days of illness, d eaths, and costs of hepatitis A treatment, public health intervention, and work loss. Each endpoint was considered separately for FSWs and patrons. We estimate vaccination of 100,000 FSWs would cost $8.1 million but reduce th e costs of hepatitis A treatment, public health intervention, and work loss by $3.0 million, $2.3 million, and $3.1 million, respectively. Vaccination would prevent approximately 2,500 symptomatic infections, 93,000 days of i llness, and 8 deaths. A vaccination policy would reduce societal costs whil e costing the health system $13,969 per YOLS, a ratio that exceeds generall y accepted standards of cost effectiveness.