Economic evaluation of a 2-dose hepatitis B vaccination regimen for adolescents

Objective. To investigate the economic implications of a 2-dose hepatitis B virus vaccination regimen compared with the current 3-dose vaccination reg imen for adolescents in 3 settings: public schools, public health clinics, and private sector settings in the United States. Methods. To measure resource utilization and costs associated with the admi nistration of the 3-dose regimen and to assess vaccination compliance rates with this regimen, primary data were collected with the use of questionnai res tailored for each setting. Conservative modeling assumptions were used to derive 2-dose compliance rates from 3-dose compliance data. The results were incorporated into a decision analytic model, which was used to examine short-term and lifetime scenarios for an adolescent cohort receiving the 2 -dose versus the 3-dose regimen. In the short-term analysis, the vaccinatio n program costs were compared for the 2 regimens. In the lifetime analysis, the model also incorporated long-term disease costs for those individuals who contract hepatitis B. Results. Predicted increases in compliance with a 2-dose vaccination regime n contributed to a higher probability of seroprotection in each setting. In the lifetime analysis, this positive impact of improved compliance resulte d in a lower infection rate and greater cost-effectiveness for the 2-dose r egimen in all settings, including private sector settings, where it cost an average of only $964 per year of life gained, and in public schools, costi ng an average of $1246 per year of life gained. In public health clinics, t he 2-dose regimen had both lower expected lifetime costs and better clinica l outcomes than the 3-dose regimen. In the short-term analysis, costs were higher for the 2-dose regimen, reflecting higher total vaccine acquisition costs without the long-term offset of cost savings from reduced infection. Sensitivity analyses identified cost per dose of vaccine and the probabilit y of completing the regimens as the most sensitive model variables. Conclusions. Improved compliance with a 2-dose regimen would contribute to a higher probability of adolescents' achieving seroprotection. When the lon g-term consequences of hepatitis B virus infection are included, the 2-dose regimen would be cost-effective compared with the 3-dose regimen in all se ttings and cost saving in public health clinic settings.