An economic evaluation of universal infant vaccination against hepatitis avirus using a combination vaccine (HiQ-HepB): a decision analytic approachto cost effectiveness

Objective: To evaluate the health impact and cost effectiveness of two infa nt vaccination strategies for protection against hepatitis B virus (HBV) in fection in the Australian population. Vaccinating only high-risk infants, a ssuming 65% compliance, was compared with universal vaccination of infants using a combination Hib-HepB vaccine, with 87.4% compliance. Method: A Markov model simulated the natural history of HBV infection and d isease in an Australian birth cohort. The cohort was divided into those at high risk of infection (infants born into high-risk families) and low-risk infants. Clinical and epidemiological data used were obtained from publishe d reports and a survey of clinical experts. The model included the health c osts associated with acute and chronic HBV infection, and the sequelae of c hronic HBV infection. Results: The model predicted that universal hepatitis B vaccination of an A ustralian birth cohort (260,000 births) would result in a 77% reduction in cases of HBV infection. The incremental cost per life year gained was $11,8 62, which is low compared with many other health care interventions. With n o discounting of costs or consequences, universal vaccination with the comb ination vaccine was predicted to save lives and reduce costs. Conclusion: There is no socially accepted threshold value for cost per life year gained to guide decisions about funding Australian health care interv entions. Nevertheless, based on these results, universal hepatitis B vaccin ation of Australian infants using a combination Hib-HepB vaccine would almo st certainly be regarded as a worthwhile investment of public funds.