Economic Analysis 20 Years after the Introduction of Universal HBV Immunisation in Bulgaria

ABSTRACT

The aim of this study was to evaluate the main economic results 20 years after the introduction of obligatory immunisation against hepatitis B virus (HBV) in Bulgaria. Prospective epidemiology and retrospective cost analysis was done. During the period 1992–2010 information was collected about the number of vaccinated individuals in the new born cohorts, and about the reported acute HBV infection cases per year in Bulgaria. The number of averted cases was calculated. Only direct medical costs were included in the analysis: the cost of ambulatory pharmacotherapy after hospital discharge of acute cases, hospital charges for acute cases, yearly pharmacotherapy of chronic hepatitis B, cost of hospitalisation due to chronic hepatitis B, and cost of cirrhosis and hepatocellular carcinoma as the most common complication of HBV infection. The net health benefits were analyzed in two scenarios—for the whole period, and for the last 10 years after considering only the acute or both the acute and chronic cases therapy.

For the whole period, the investments still prevail over the benefits because of the relative parity between the total number of infections and averted cases. The latter is true for both scenarios—considering only the acute cases cost, and considering both the acute and chronic cases, as well as the complications cost. If the calculations are repeated only for the last 10 years of the observed period (2001 - 2010), the investments nearly equalize the benefits, most evidently in the second scenario, probably due to the highest number of averted chronic cases and hospitalizations.

Universal vaccination against HBV is socially beneficial for the Bulgarian population. Its positive economic effects became visible during the last 10 years since its introduction in the immunisation calendar.

Keywords:

• Hepatitis B
• vaccination
• health economics
• cost of pharmacotherapy