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Recommendations for Prevention of Hepatitis A Based on a Cost-Effectiveness Analysis
Tormans1, Van Damme P, Van Doorslaer E
1Department of Epidemiology and Community Medicine, University of Antwerp, Belgium.
Journal of Travel Medicine
|September 1, 1994
Summary
For travelers, hepatitis A prevention strategy depends on travel frequency and duration. Passive immunization is cost-effective for infrequent, short trips, while vaccination is better for frequent or long journeys.
Area of Science:
- Epidemiology
- Public Health
- Travel Medicine
Background:
- Hepatitis A virus (HAV) infection is a significant risk for travelers from low-endemic regions visiting high-endemic areas.
- Optimal prevention strategies require consideration of travel patterns and individual immunity.
Purpose of the Study:
- To determine the most cost-effective strategies for preventing hepatitis A in travelers.
- To establish indications for active immunization, screening, and passive immunization based on risk factors.
Main Methods:
- Cost-effectiveness analysis comparing no prophylaxis, active immunization, screening followed by active immunization, and passive immunization.
- Modeling based on travel frequency, duration, destination endemicity, and natural immunity.
Main Results:
- Passive immunization (immune globulins) is most cost-effective for travelers with infrequent (≤2 trips/10 years) or short journeys.
- Active immunization (vaccination) is more cost-effective for frequent travelers or those on journeys of 6 months or longer.
- Pretravel screening before vaccination is beneficial unless natural immunity is highly probable.
Conclusions:
- The optimal hepatitis A prevention strategy is individualized based on travel behavior, destination, and immune status.
- Cost-effectiveness is influenced by vaccine/screening costs, travel details, and endemicity levels.
- Decision-tree models aid in selecting the appropriate prevention strategy for travelers.