[Economic evaluation of various hepatitis B vaccination Strategies in Switzerland]

The aim of this study was to assess and compare the costs and epidemiological impact of different vaccination strategies against hepatitis B in Switzerland. A birth cohort of 85,000 individuals was followed over its lifetime using a decision tree analysis. Published data were used to simulate the risk of hepatitis B virus (HBV) infection in the cohort, the consecutive clinical outcomes and the associated costs. Five vaccination scenarios were assessed and compared to the baseline, defined as the high-risk group strategy without prenatal screening. These were: 1. systematic prenatal screening and vaccination of newborns at risk; 2. universal vaccination of infants; 3. universal vaccination of schoolchildren; 4. universal vaccination of infants and schoolchildren; 5. universal vaccination of infants, schoolchildren and adolescents. Results are presented using a 3% annual discounting rate. Systematic prenatal screening reduced the number of chronic infections by 11% and prevented 6 deaths per year. The cost per year of life saved was estimated to be 23,350 CHF. The four universal vaccination scenarios had a much larger impact on the number of chronic infections and deaths prevented (reduction of 68-78%). Costs per year of life saved for universal vaccination ranged from 8820 CHF (infant strategy) to 12,380 CHF (schoolchildren strategy). However, the vaccination of schoolchildren would be as cost-effective as the vaccination of infants using alternative assumptions (a lower compliance for infants compared to schoolchildren or the need for a booster later in the life for infants). The benefit-cost ratio ranged from 1.2 (systematic prenatal screening and vaccination of newborns at risk) to 2.9 (vaccination of infants). Universal vaccination against hepatitis B is more cost-effective than the current selective vaccination strategy of newborns.