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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”


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.
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
Alan Franciscus
Editor-in-Chief, Hepatitis C Virus Advocate