Is vaccination against hepatitis B efficient? A review of world literature

We report on the result of a study aimed at assessing the variability of assumptions upon which economic models for the introduction of vaccination against Hepatitis B are based, the conclusions reached and define a minimum set of methodological standards upon which future economic studies on vaccines should be based. We identified 116 published and unpublished works by Medline literature searches, consulting private databases and corresponding with all authors and researchers active in economic evaluation of vaccines. All works were assessed but we included in our review only those which were original economic analyses (90 studies). Principal epidemiological and economic variables were extracted and compared where possible. Rough manipulations were carried out to make the data comparable. We found profound variability on the main parameters of the efficiency equation (disease incidence, costing methods, use of marginal theory, discounting and study time-span, sensitivity analysis and reporting methods). We also found inconsistencies in definition and study design in 38% of a subset of studies. Although we found scarce decision-making impact, we believe that due to uncertain or unclear methodology, few studies reach valid conclusions. In future decisions may be based on biased evidence and scarce resources committed to untested programmes. There is an urgent need to standardise study methods and define a common set of procedures.