Cost-effectiveness of hepatitis B vaccination in haemodialysis patients

Vaccination against hepatitis B virus is an important means of controlling the infection, but its role in haemodialysis patients has been questioned due to the latter's impaired immune response.

Forty-eight of 79 haemodialysis patients who were negative for antibodies to both hepatitis B surface and core antigens were entered into a vaccination programme. Standard doses of a plasma-derived vaccine were administered into the deltoid muscle at 0, 1, 2 and 4 months, and the antibody response was measured at 1 and 2 months after the third and fourth doses.

The peak mean antibody titre of 372 IU/l was recorded at 1 month after the fourth dose, and the maximum response rate was achieved at 2 months after the final dose. Seroconversion occurred in 26 of 36 patients (72%) who completed the programme, and protective levels of antibody above 10 IU/l were found in 25 of 36 patients (69%). Cost analysis of the project revealed a net saving of +/- R90/patient entered at the end of the first year, due to the reduced number of patients requiring monthly surveillance tests for hepatitis B surface antigen. After that, an annual saving of +/- R380/patient is projected.

In view of the high prevalence of chronic hepatitis B carriers in the South African population, the reduction in the number of patients at risk of infection, combined with a net cost saving, makes it reasonable to recommend vaccination in all non-immune haemodialysis patients despite a reduced response rate.