Universal vaccination of children against hepatitis A in Chile: a cost-effectiveness study
Arnoldo Quezada1, Florence Baron-Papillon, Laurent Coudeville
1Faculty of Medicine of University of Chile, Santiago, Chile.
Insights
Routine toddler hepatitis A vaccination significantly cuts infections and deaths in Chile. This public health program becomes cost-saving within six years, offering substantial economic and health benefits.
Area of Science:
- Public Health
- Epidemiology
- Health Economics
Background:
- Hepatitis A poses a significant public health challenge.
- Understanding the economic and healthcare impact of vaccination programs is crucial for policy decisions.
Purpose of the Study:
- To evaluate the healthcare and economic impact of routine hepatitis A vaccination for toddlers in Chile.
- To assess the cost-effectiveness of a two-dose hepatitis A vaccination schedule.
Main Methods:
- A dynamic model of hepatitis A infection was utilized.
- The model incorporated Chile's changing hepatitis A epidemiology and vaccine-induced herd immunity.
- Analysis was conducted from public payer and societal perspectives, with costs in 2005 U.S. dollars.
Main Results:
- Toddler vaccination rapidly reduced the hepatitis A healthcare burden, with a 76.6% annual fall in infections and 59.7% in deaths (base case).
- Even at 50% coverage, infection rates were substantially reduced.
- The program yielded economic benefits, saving $4,984 per life-year gained and becoming cost-saving after 6 years.
Conclusions:
- Routine toddler hepatitis A vaccination effectively reduces symptomatic cases and mortality.
- The two-dose schedule is projected to be less expensive than disease-related costs within six years.
- Findings support implementing a routine toddler vaccination program in Chile.
Objective:
To evaluate the healthcare and economic impact of routine hepatitis A vaccination of toddlers in Chile.
Methods:
We used a dynamic model of hepatitis A infection to evaluate the impact of a two-dose vaccination program, administered at ages 12 and 18 months. The model incorporated the changing epidemiology of hepatitis A in Chile and the development of vaccine-induced herd immunity. Our analysis was conducted from the public payer perspective, and an estimation of the societal perspective was performed. Costs are expressed in 2005 U.S. dollars.
Results:
Vaccination of toddlers rapidly reduced the healthcare burden of hepatitis A. In the base case (95% vaccination coverage, 100-year time horizon, 1% annual decrease in force of infection), the average number of infections fell by 76.6% annually, and associated deaths fell by 59.7%. Even at 50% coverage, the program reduced infection rates substantially. Routine vaccination of toddlers had economic as well as health benefits, saving $4,984 per life-year gained (base case scenario). The program became cost saving after 6 years, and its overall cost-effectiveness per life-year gained was largely unaffected by changes in disease-related costs, herd immunity, coverage rate, and annual decrease in force of infection.
Conclusions:
Routine vaccination of toddlers will reduce the rates of symptomatic hepatitis A and associated mortality. The two-dose schedule evaluated here will be less expensive than disease-related costs in the absence of vaccination from the sixth year of its implementation. These findings support the establishment of a routine vaccination program for toddlers in Chile.
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