1. Targeted outreach hepatitis B vaccination program in high-risk adults: The fundamental challenge of the last mile.
- Author
-
Mangen MJ, Stibbe H, Urbanus A, Siedenburg EC, Waldhober Q, de Wit GA, and van Steenbergen JE
- Subjects
- Adult, Community-Institutional Relations economics, Cost-Benefit Analysis, Female, Health Care Costs, Hepatitis B epidemiology, Hepatitis B virology, Heterosexuality, Humans, Male, Netherlands epidemiology, Public Health economics, Quality-Adjusted Life Years, Sex Workers, Hepatitis B prevention & control, Hepatitis B Vaccines administration & dosage, Immunization Programs economics, Risk-Taking
- 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., (Copyright © 2017 Elsevier Ltd. All rights reserved.)
- Published
- 2017
- Full Text
- View/download PDF