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Testing for Antibody to Hepatitis A to Decrease the Cost of Hepatitis A Prophylaxis With Immune Globulin or Hepatitis A Vaccines

Testing for Antibody to Hepatitis A to Decrease the Cost of Hepatitis A Prophylaxis With Immune... Abstract Background: The introduction of new vaccines to prevent hepatitis A infection raises the question of the cost of these vaccines relative to immune globulin when short-term protection against hepatitis A is required. Since the prevalence of hepatitis A antibodies (anti-HAV) in the US population increases rapidly with age, testing for anti-HAV may decrease the cost of vaccination programs. Methods: A cost-analysis model was developed that incorporates the cost of immune globulin or hepatitis A vaccine, the number of doses of vaccine, the cost of testing for anti-HAV in either commercial or public-sector laboratories, and the prevalence of anti-HAV in the general population by age. Results: In comparison with hepatitis A vaccines, with expected costs between $10 and $25 per dose, use of immune globulin for postexposure prophylaxis or preexposure short-term (≤6 months) prophylaxis is much less expensive for all age groups. Testing for anti-HAV does not significantly diminish the cost of immune globulin regimens. In contrast, if anti-HAV testing is performed in a public-sector laboratory at $10 per test, and hepatitis A vaccine costs $10 per dose, testing reduces vaccination costs in those 40 years of age or older for a two-dose vaccine regimen and in those 30 years of age or older for a three-dose regimen. At the other end of the spectrum, if vaccine costs $35 per dose, commercial testing for anti-HAV at $25 per person reduces the costs in those 30 years of age or older if either a two- or three-dose regimen is elected. However, vaccine savings are realized in those 10 years and older if public-sector testing is performed and three doses of vaccine at $35 per dose are utilized. In an intermediate scenario of public-sector testing and vaccines costing $25 per dose, the cost would also be reduced in those 30 years old or older. Conclusions: Testing for anti-HAV in frequent travelers, international government, business, and volunteer workers, military personnel, etc, may be an effective means of decreasing costs of hepatitis A prevention.(Arch Intern Med. 1994;154:663-668) References 1. Steffen R. Travel medicine: prevention based on epidemiological data . Trans R Soc Trop Med Hyg . 1991;85:156-162.Crossref 2. Steffen R, Rickenbach M, Wilhelm U, Helminger A, Schar M. Health problems after travel to developing countries . J Infect Dis . 1987;156:84-91.Crossref 3. Winokur P, Stapleton J. Immunoglobulin prophylaxis for hepatitis A . Clin Infect Dis . 1992;14:580-586.Crossref 4. Tilzey A, Palmer S, Barrow S, et al. Clinical trial with inactivated hepatitis A vaccine and recommendations for its use . BMJ . 1992;304:1272-1276.Crossref 5. Warwick C. Hepatitis A vaccines considered for licensing . JAMA . 1992;267: 2007-2008.Crossref 6. Ellerbeck E, Lewis J, Nalin D, et al. Safety profile and immunogenicity of an inactivated vaccine derived from an attenuated strain of hepatitis A . Vaccine . 1992;10:668-671.Crossref 7. Bryan J, McCardle P, Fogarty J, South-Paul J, Legters L, Perine P. Randomized trial of concurrent hepatitis A and B vaccines . In: Program and abstracts of the Interscience Conference on Antimicrobial Agents and Chemotherapy; October 11-14, 1992 ; Anaheim, Calif. Abstract 1386. 8. Werzberger A, Mensch B, Kuter B, et al. A controlled trial of a formalin-inactivated hepatitis A vaccine in healthy children . N Engl J Med . 1992;327: 453-457.Crossref 9. Shapiro C, McQuillan G, Robertson B, Hadler S, Margolis H. Seroepidemiology of hepatitis A infection in the United States . In: Program and abstracts of the 1990 International Symposium on Viral Hepatitis and Liver Disease; April 4-8, 1990 ; Houston, Tex. Abstract 22. 10. Hepatitis A: a vaccine at last . Lancet . 1992;339:1198-1199.Crossref 11. Tormans G, Van Damme P, Van Doorslaer E. Cost-effectiveness analysis of hepatitis A prevention in travelers . Vaccine . 1992;10:S88-S92.Crossref 12. Pierce F, Cappelo M, Bernard K. Subclinical infection with hepatitis A in Peace Corps volunteers following immune globulin prophylaxis . Am J Trop Med Hyg . 1990;42:465-469. 13. Buckley R. Immunodeficiency diseases . JAMA . 1992;268:2797-2806.Crossref 14. Balayan M. HEV infection: historical perspectives, global epidemiology, and clinical features . In: Hollinger F, Lemon S, Margolis H, eds. Viral Hepatitis and Liver Disease . Baltimore, Md: Williams & Wilkins; 1991:498-501. 15. Hyams K, Purdy M, Kaur M, et al. Acute sporadic hepatitis E in Sudanese children: analysis based on a new Western blot assay . J Infect Dis . 1992;165: 1001-1005.Crossref 16. Lok A, Kwan W-K, Moeckli R, et al. Seroepidemiological survey of hepatitis E in Hong Kong by recombinant-based enzyme immunoassays . Lancet . 1992; 340:1205-1208.Crossref 17. Conrad M, Lemon S. Prevention of endemic icteric viral hepatitis by administration of immune serum gamma globulin . J Infect Dis . 1987;182:56-63.Crossref 18. Centers for Disease Control and Prevention. Hepatitis Surveillance Report No. 54 . Atlanta, Ga: Centers for Disease Control and Prevention; 1992. 19. Heinricy U, Pfisterer M, Stierhop Y-D, Flehmig A. Schedule-dependent immune response to hepatitis A vaccination . In: Hollinger F, Lemon S, Margolis H, eds. Viral Hepatitis and Liver Disease . Baltimore, Md: Williams & Wilkins; 1991: 108-110. 20. Hill D. Pre-travel health, immunization status, and demographics of travel to the developing world for individuals visiting a travel medicine service . Am J Trop Med Hyg . 1991;45:263-270. 21. Centers for Disease Control. Health Information for International Travel . Atlanta, Ga: Centers for Disease Control and Prevention; 1991. Dept of Health and Human Services publication (CDC) 91-8280. 22. Midthun K, Ellerbeck E, Clements M, et al. Hepatitis A virus antibody levels in vaccine or immune globulin recipients . In: Program and abstracts of the 1992 Interscience Conference on Antimicrobial Agents and Chemotherapy; October 11-24, 1992 ; Anaheim, Calif. Abstract 1384. 23. McQuillan G, Townsend T, Fields H, Carroll M, Leahy M, Polk B. Seroepidemiology of hepatitis B virus infection in the United States . Am J Med . 1989; 87( (suppl 3A) ):5s-10s.Crossref 24. Straus S, Ostrove J, Inchauspe G, et al. Varicella-zoster virus infections . Ann Intern Med . 1988;108:221-237.Crossref 25. Edwards K, Decker M, Graham B, Mezzatesta J, Scott J, Hackell J. Adult immunization with acellular pertussis vaccine . JAMA . 1993;269:53-94.Crossref 26. Centers for Disease Control. Protection against viral hepatitis: recommendations of the Immunization Practices Advisory Committee (ACIP) . MMWR Morb Mortal Wkly Rep . 1990;39:RR-2. 27. Kelley P, Petruccelli B, Stehr-Green P, Erickson R, Mason C. The susceptibility of young adult Americans to vaccine-preventable infections: a national serosurvey of US Army recruits . JAMA . 1991;266:2724-2729.Crossref 28. Wallace M, Bowler W, Murray N, Brodine S, Oldfield E. Treatment of adult varicella with oral acyclovir . Ann Intern Med . 1992;117:358-363.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Testing for Antibody to Hepatitis A to Decrease the Cost of Hepatitis A Prophylaxis With Immune Globulin or Hepatitis A Vaccines

Archives of Internal Medicine , Volume 154 (6) – Mar 28, 1994

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Publisher
American Medical Association
Copyright
Copyright © 1994 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1994.00420060093010
Publisher site
See Article on Publisher Site

Abstract

Abstract Background: The introduction of new vaccines to prevent hepatitis A infection raises the question of the cost of these vaccines relative to immune globulin when short-term protection against hepatitis A is required. Since the prevalence of hepatitis A antibodies (anti-HAV) in the US population increases rapidly with age, testing for anti-HAV may decrease the cost of vaccination programs. Methods: A cost-analysis model was developed that incorporates the cost of immune globulin or hepatitis A vaccine, the number of doses of vaccine, the cost of testing for anti-HAV in either commercial or public-sector laboratories, and the prevalence of anti-HAV in the general population by age. Results: In comparison with hepatitis A vaccines, with expected costs between $10 and $25 per dose, use of immune globulin for postexposure prophylaxis or preexposure short-term (≤6 months) prophylaxis is much less expensive for all age groups. Testing for anti-HAV does not significantly diminish the cost of immune globulin regimens. In contrast, if anti-HAV testing is performed in a public-sector laboratory at $10 per test, and hepatitis A vaccine costs $10 per dose, testing reduces vaccination costs in those 40 years of age or older for a two-dose vaccine regimen and in those 30 years of age or older for a three-dose regimen. At the other end of the spectrum, if vaccine costs $35 per dose, commercial testing for anti-HAV at $25 per person reduces the costs in those 30 years of age or older if either a two- or three-dose regimen is elected. However, vaccine savings are realized in those 10 years and older if public-sector testing is performed and three doses of vaccine at $35 per dose are utilized. In an intermediate scenario of public-sector testing and vaccines costing $25 per dose, the cost would also be reduced in those 30 years old or older. Conclusions: Testing for anti-HAV in frequent travelers, international government, business, and volunteer workers, military personnel, etc, may be an effective means of decreasing costs of hepatitis A prevention.(Arch Intern Med. 1994;154:663-668) References 1. Steffen R. Travel medicine: prevention based on epidemiological data . Trans R Soc Trop Med Hyg . 1991;85:156-162.Crossref 2. Steffen R, Rickenbach M, Wilhelm U, Helminger A, Schar M. Health problems after travel to developing countries . J Infect Dis . 1987;156:84-91.Crossref 3. Winokur P, Stapleton J. Immunoglobulin prophylaxis for hepatitis A . Clin Infect Dis . 1992;14:580-586.Crossref 4. Tilzey A, Palmer S, Barrow S, et al. Clinical trial with inactivated hepatitis A vaccine and recommendations for its use . BMJ . 1992;304:1272-1276.Crossref 5. Warwick C. Hepatitis A vaccines considered for licensing . JAMA . 1992;267: 2007-2008.Crossref 6. Ellerbeck E, Lewis J, Nalin D, et al. Safety profile and immunogenicity of an inactivated vaccine derived from an attenuated strain of hepatitis A . Vaccine . 1992;10:668-671.Crossref 7. Bryan J, McCardle P, Fogarty J, South-Paul J, Legters L, Perine P. Randomized trial of concurrent hepatitis A and B vaccines . In: Program and abstracts of the Interscience Conference on Antimicrobial Agents and Chemotherapy; October 11-14, 1992 ; Anaheim, Calif. Abstract 1386. 8. Werzberger A, Mensch B, Kuter B, et al. A controlled trial of a formalin-inactivated hepatitis A vaccine in healthy children . N Engl J Med . 1992;327: 453-457.Crossref 9. Shapiro C, McQuillan G, Robertson B, Hadler S, Margolis H. Seroepidemiology of hepatitis A infection in the United States . In: Program and abstracts of the 1990 International Symposium on Viral Hepatitis and Liver Disease; April 4-8, 1990 ; Houston, Tex. Abstract 22. 10. Hepatitis A: a vaccine at last . Lancet . 1992;339:1198-1199.Crossref 11. Tormans G, Van Damme P, Van Doorslaer E. Cost-effectiveness analysis of hepatitis A prevention in travelers . Vaccine . 1992;10:S88-S92.Crossref 12. Pierce F, Cappelo M, Bernard K. Subclinical infection with hepatitis A in Peace Corps volunteers following immune globulin prophylaxis . Am J Trop Med Hyg . 1990;42:465-469. 13. Buckley R. Immunodeficiency diseases . JAMA . 1992;268:2797-2806.Crossref 14. Balayan M. HEV infection: historical perspectives, global epidemiology, and clinical features . In: Hollinger F, Lemon S, Margolis H, eds. Viral Hepatitis and Liver Disease . Baltimore, Md: Williams & Wilkins; 1991:498-501. 15. Hyams K, Purdy M, Kaur M, et al. Acute sporadic hepatitis E in Sudanese children: analysis based on a new Western blot assay . J Infect Dis . 1992;165: 1001-1005.Crossref 16. Lok A, Kwan W-K, Moeckli R, et al. Seroepidemiological survey of hepatitis E in Hong Kong by recombinant-based enzyme immunoassays . Lancet . 1992; 340:1205-1208.Crossref 17. Conrad M, Lemon S. Prevention of endemic icteric viral hepatitis by administration of immune serum gamma globulin . J Infect Dis . 1987;182:56-63.Crossref 18. Centers for Disease Control and Prevention. Hepatitis Surveillance Report No. 54 . Atlanta, Ga: Centers for Disease Control and Prevention; 1992. 19. Heinricy U, Pfisterer M, Stierhop Y-D, Flehmig A. Schedule-dependent immune response to hepatitis A vaccination . In: Hollinger F, Lemon S, Margolis H, eds. Viral Hepatitis and Liver Disease . Baltimore, Md: Williams & Wilkins; 1991: 108-110. 20. Hill D. Pre-travel health, immunization status, and demographics of travel to the developing world for individuals visiting a travel medicine service . Am J Trop Med Hyg . 1991;45:263-270. 21. Centers for Disease Control. Health Information for International Travel . Atlanta, Ga: Centers for Disease Control and Prevention; 1991. Dept of Health and Human Services publication (CDC) 91-8280. 22. Midthun K, Ellerbeck E, Clements M, et al. Hepatitis A virus antibody levels in vaccine or immune globulin recipients . In: Program and abstracts of the 1992 Interscience Conference on Antimicrobial Agents and Chemotherapy; October 11-24, 1992 ; Anaheim, Calif. Abstract 1384. 23. McQuillan G, Townsend T, Fields H, Carroll M, Leahy M, Polk B. Seroepidemiology of hepatitis B virus infection in the United States . Am J Med . 1989; 87( (suppl 3A) ):5s-10s.Crossref 24. Straus S, Ostrove J, Inchauspe G, et al. Varicella-zoster virus infections . Ann Intern Med . 1988;108:221-237.Crossref 25. Edwards K, Decker M, Graham B, Mezzatesta J, Scott J, Hackell J. Adult immunization with acellular pertussis vaccine . JAMA . 1993;269:53-94.Crossref 26. Centers for Disease Control. Protection against viral hepatitis: recommendations of the Immunization Practices Advisory Committee (ACIP) . MMWR Morb Mortal Wkly Rep . 1990;39:RR-2. 27. Kelley P, Petruccelli B, Stehr-Green P, Erickson R, Mason C. The susceptibility of young adult Americans to vaccine-preventable infections: a national serosurvey of US Army recruits . JAMA . 1991;266:2724-2729.Crossref 28. Wallace M, Bowler W, Murray N, Brodine S, Oldfield E. Treatment of adult varicella with oral acyclovir . Ann Intern Med . 1992;117:358-363.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Mar 28, 1994

References