[Cost-effectiveness analysis of different alternatives of universal vaccination against hepatitis B in the region of Murcia]

Background: Programs of universal vaccination against hepatitis B have been introduced in Spain with different vaccination calendars. The aim of this study was to determine the most profitable alternative to universal vaccination against hepatitis B.
Methods: A cost-effectiveness study was carried out evaluating the following alternatives: 1) Vaccination of all newborns, 2) vaccination of all preadolescent children (11 years of age), 3) vaccination of all newborns and preadolescents. This study was performed using data from the Autonomic Community of Murcia in 1993 from the perspective of the Regional Council of Health. The costs of the vaccination program are marginal. Cost-effectiveness analysis was carried out in two ways: taking only the direct costs of the program into account and considering the adverse effects and saving in the treatment of the cases avoided. Analysis of sensitivity was performed with the use of different discount rates.
Results: The most expensive alternative is vaccination of newborns (118,990 pesetas per case) with vaccination of preadolescent proving to be the most profitable (64,476 pesetas per case avoided) allowing intervention during the period of life with maximum incidence of infection. Nonetheless, the combined alternative of newborns and preadolescents differs little (82,840 pesetas per case avoided) from the latter alternative allowing short term control of the infection and contributing to elimination of the disease. Analysis of sensitivity demonstrated vaccination of preadolescents to be greater than the remaining alternatives.
Conclusions: Using cost-effectiveness criteria the preadolescent vaccination strategy against hepatitis B virus should be implemented and incorporated into the vaccination calendars.