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Economic
Implication of Hepatitis B Vaccination at Sexually Transmitted
Disease Clinics in the United States
K. Billahl, I. Buffmgtonl, C. Weinbauml, E. Mastl, P. Murray,
R. Gunnl,2, H.
Margolis1,
1 Centers for Disease Control and Prevention, Atlanta, GA, USA
2 San Diego County Health and Human Services Agency, San
Diego, CA, USA
Sexually transmitted disease (SID) clinics are effective
venues for
vaccinating adults at increased risk of hepatitis B virus (HBV)
infection in
the US. The cost of a national program to vaccinate the
estimated 2 million
clients who attend STD clinics annually was estimated using
program specific
data from a demonstration project at a large STD clinic in San
Diego,
California. A decision model that included program
interventions and the
outcomes of HBV infection was used to estimate discounted
direct medical
costs with and without vaccination. Cost of antiviral
treatment and liver
transplants were not included. Age specific estimates of HBV
infection
prevalence among STD clinic clients were used in a catalytic
model to
determine the lifetime risk of HBV infection, and vaccination
service costs
were estimated from a time-motion study of provider-STD client
interactions.
Without a national vaccination program, an estimated 237,000
new HBV
infections would occur over the lifetime of the 2 million STD
clinic
clients, and would cost $198 million in discounted direct
medical costs for
acute and chronic hepatitis. Based on estimated completion
rates in a
national vaccination program, 1,480,000 clients would receive
one dose,
784,400 two doses, and 447,108 three doses of vaccine. This
level of vaccine
coverage would prevent 102,389 HBV infections from the
expected number of
new infections without vaccination, a 43% reduction. The
vaccination program
would cost an estimated $69 million, and HBV infections not
averted by the
program would cost an estimated $112 million, resulting in a
net savings of
$17 million.
This cost model demonstrates that hepatitis B vaccination
implemented at STD
clinics throughout the US would result in a net savings in
medical costs
from the reduction in new infections. The extent of this
savings should be
considered conservative since it does not include antiviral
treatment,
liver-transplant, and work-loss.
Hepatitis B: 11th International Symposium on Viral
Hepatitis and Liver
Disease
Alan Franciscus
Editor-in-Chief, Hepatitis C Virus Advocate
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