Economic evaluations of hepatitis A vaccination in middle-income countries

Abstract

Economic evaluations of hepatitis A vaccination are important to assist national and international policy makers in different jurisdictions on making effective decisions. Up to now, a comprehensive review of the potential health and economic benefits on hepatitis A vaccination in middle-income countries (MICs) has not been performed yet. In this study, we reviewed the literature on the cost–effectiveness of hepatitis A vaccination in MICs. Most of the studies confirmed that hepatitis A vaccination was cost effective or even cost saving under certain conditions. We found that vaccine price, medical costs, incidence and discount rate were the most influential parameters on the sensitivity analyses. Vaccine price has been shown as a barrier for MICs in implementing universal vaccination of hepatitis A. Given their relatively limited financial resources, implementation of single-dose vaccination could be considered. Despite our findings, we argue that further economic evaluations in MICs are still required in the near future.

Keywords::

• economic evaluation
• hepatitis A
• middle-income countries
• vaccination

Financial & competing interests disclosure

MJ Postma received grants, honoraria and travel stipends from various pharmaceutical companies, inclusive those interested in the subject matter of this paper. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • Approaches to conduct economic evaluations of hepatitis A vaccination in middle-income countries (MICs) varied widely and we found that several studies did not completely fulfill the criteria on quality assessment.

• • We found evidence that universal hepatitis A vaccination of infants, children and adolescents in MICs has favorable cost–effectiveness in high- and intermediate-endemic countries and potentially unfavorable in low-endemic countries.

• • Vaccine price, medical costs for hepatitis A virus, incidence and discount rates were found as the most influential parameters in the sensitivity analyses.

• • Implementation of a single-dose hepatitis A vaccine has been proven to potentially be a cost-saving intervention in one of the MICs.