Background: Many patients seen at U.S. sexually transmitted disease (STD) clinics are offered hepatitis B vaccination. Substituting hepatitis A/B vaccine would provide additional protection but increase costs.
Goal: The goal was to estimate the cost effectiveness of hepatitis A/B versus B vaccination for 1,000,000 public STD clinic attenders.
Study Design: A Markov model of hepatitis A outcomes was developed using published literature, U.S. government databases, and expert panel opinion. Added vaccination costs were compared with savings from reduced hepatitis A treatment. Net costs were compared with life-years saved and quality-adjusted life-years (QALYs) gained.
Results: Substituting hepatitis A/B vaccine would prevent 2263 overt hepatitis A infections, 292 hospitalizations, 8 premature deaths, and the loss of 281 QALYs. Net health system costs would be $20,892 per life-year saved, or $13,397 per QALY gained.
Conclusion: Substituting hepatitis A/B for hepatitis B vaccine would reduce morbidity and mortality in a cost-effective manner.
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