Testing for antibody to hepatitis A to decrease the cost of hepatitis A prophylaxis with immune globulin or hepatitis...

Area of Science:

• Public Health
• Infectious Disease Prevention
• Health Economics

Background:

• New hepatitis A vaccines prompt cost comparisons with immune globulin for short-term protection.
• Hepatitis A antibody prevalence increases with age in the US population.
• Pre-vaccination antibody testing may reduce overall vaccination program costs.

Purpose of the Study:

• To evaluate the cost-effectiveness of hepatitis A vaccination versus immune globulin for short-term prophylaxis.
• To determine the impact of pre-vaccination hepatitis A antibody testing on prevention costs across different age groups and testing scenarios.

Main Methods:

• A cost-analysis model was developed.
• Model incorporated costs of immune globulin, hepatitis A vaccine (varying doses and prices), and anti-HAV testing (commercial vs. public-sector labs).
• Prevalence of anti-HAV in the general population by age was included.

Main Results:

• Immune globulin is more cost-effective than hepatitis A vaccines for short-term (< or = 6 months) prophylaxis in all age groups.
• Anti-HAV testing minimally impacts immune globulin regimen costs.
• Testing reduces vaccination costs in individuals aged 30-40+ depending on vaccine cost, number of doses, and laboratory type (public-sector testing is more cost-effective).

Conclusions:

• Pre-vaccination anti-HAV testing can be a cost-effective strategy for hepatitis A prevention in specific populations.
• Targeted testing is particularly beneficial for frequent travelers, international workers, and military personnel.
• Cost savings are realized when testing is combined with vaccination in older age cohorts or when using public-sector testing facilities.