Design
Decision analysis model comparing (1) prevaccination testing for hepatitis B surface antibodies, (2) no testing, and (3) testing at the same time as the first vaccine dose. Sensitivity analyses of the first two strategies were performed varying the seroprevalence of hepatitis B surface antibodies, compliance with follow-up, and costs of testing.

Setting
Charges for testing and vaccination were obtained from Children's Hospital and Medical Center in Seattle, Wash. Vaccination compliance, hepatitis B surface antibodies seroprevalence, and vaccine response rates are from published literature.

Patients
A hypothetical cohort of 100 000 11-year-old children presenting for well-child care.

Main Outcome Measures
Rate of complete vaccination, cost of testing and vaccination for each cohort, and cost per patient protected from hepatitis B virus.

Results
No testing was the most cost-effective strategy. Prevaccination testing elevated costs by $2.9 million for every 100 000 patients and lowered the rate of complete vaccination by 22% compared with vaccination without testing. For prevaccination testing to be cost-effective, the seroprevalence of hepatitis B surface antibodies needed to be greater than 40%. As the seroprevalence of hepatitis B surface antibodies decreased, the ratio of testing costs to vaccination costs had to decrease for prevaccination testing to remain cost-effective. Even with perfect compliance, prevaccination testing required high seroprevalence rates to be cost-effective.

Conclusions
For most populations of preadolescents and adolescents, prevaccination testing for hepatitis B virus is not effective in terms of cost or rate of complete vaccination.

(Arch Pediatr Adolesc Med. 1994;148:915-920)