1. Targeted outreach hepatitis B vaccination program in high-risk adults : The fundamental challenge of the last mile
- Author
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Mangen, M.J.J., Stibbe, H., Urbanus, A., Siedenburg, E.C., Waldhober, Q., Wit, G.A. de, Steenbergen, J.E. van, and National Working Grp Hepatit
- Subjects
Male ,Cost effectiveness ,Cost-Benefit Analysis ,Men who have sex with men ,0302 clinical medicine ,Quality of life ,Medicine ,030212 general & internal medicine ,Commercial sex workers ,Men having sex with men ,Netherlands ,Cost-effectiveness analysis ,Health Care Costs ,Hepatitis B ,Community-Institutional Relations ,Vaccination ,Infectious Diseases ,Molecular Medicine ,Female ,Quality-Adjusted Life Years ,Public Health ,0305 other medical science ,Adult ,medicine.medical_specialty ,03 medical and health sciences ,Risk-Taking ,Immunology and Microbiology(all) ,Journal Article ,Humans ,Hepatitis B Vaccines ,Heterosexuality ,030505 public health ,Sex Workers ,General Veterinary ,General Immunology and Microbiology ,Hepatitis B virus vaccination ,business.industry ,Immunization Programs ,Public health ,Environmental and Occupational Health ,Public Health, Environmental and Occupational Health ,High-risk group ,medicine.disease ,Hard drug users ,veterinary(all) ,Economic evaluation ,Immunology ,Cost-effectiveness ,business ,Demography - Abstract
Background The aim of this study was to evaluate the cost-effectiveness of the on-going decentralised targeted hepatitis B vaccination program for behavioural high-risk groups operated by regional public health services in the Netherlands since 1-November-2002. Target groups for free vaccination are men having sex with men (MSM), commercial sex workers (CSW) and hard drug users (HDU). Heterosexuals with a high partner change rate (HRP) were included until 1-November-2007. Methods Based on participant, vaccination and serology data collected up to 31-December-2012, the number of participants and program costs were estimated. Observed anti-HBc prevalence was used to estimate the probability of susceptible individuals per risk-group to become infected with hepatitis B virus (HBV) in their remaining life. We distinguished two time-periods: 2002–2006 and 2007–2012, representing different recruitment strategies and target groups. Correcting for observed vaccination compliance, the number of future HBV-infections avoided was estimated per risk-group. By combining these numbers with estimates of life-years lost, quality-of-life losses and healthcare costs of HBV-infections - as obtained from a Markov model-, the benefit of the program was estimated for each risk-group separately. Results The overall incremental cost-effectiveness ratio of the program was €30,400/QALY gained, with effects and costs discounted at 1.5% and 4%, respectively. The program was more cost-effective in the first period (€24,200/QALY) than in the second period (€42,400/QALY). In particular, the cost-effectiveness for MSM decreased from €20,700/QALY to €47,700/QALY. Discussion and conclusion This decentralised targeted HBV-vaccination program is a cost-effective intervention in certain unvaccinated high-risk adults. Saturation within the risk-groups, participation of individuals with less risky behaviour, and increased recruitment investments in the second period made the program less cost-effective over time. The project should therefore discus how to reduce costs per risk-group, increase effects or when to integrate the vaccination in regular healthcare.
- Published
- 2017