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Clinical and Economic Impact of a Combination Haemophilus influenzae and Hepatitis B Vaccine
Estimating Cost-effectiveness Using Decision Analysis
A. Mark Fendrick, MD;
Jason H. Lee, MD;
Cory LaBarge;
Henry A. Glick, MA
Arch Pediatr Adolesc Med. 1999;153:126-136.
Background Compliance with hepatitis B virus (HBV) vaccine remains suboptimal, despite a recommendation by the Advisory Committee on Immunization Practices of the US Public Health Service that all newborns be vaccinated. Although a combined HBV–Haemophilus influenzae type b (Hib) vaccine may improve acceptance of the HBV vaccine, the clinical and economic consequences of this intervention are uncertain.
Objectives To compare the health impact and cost-effectiveness of the following 2 immunization strategies: current practice of administering HBV vaccine separately (75% compliance) and Hib vaccine alone or as part of a multivalent vaccine (95% compliance); and strategy of delivering a combined HBV-Hib vaccine (95% compliance).
Design A Markov model simulated the natural history of acute and chronic HBV and Hib disease in a cohort of US newborns. Clinical and economic variables were obtained from published reports.
Results The Hib-related outcomes were the same in both strategies, because the efficacy and compliance with Hib vaccine were assumed to be equivalent in both. A 53% reduction in the number of cases of HBV infection with the combination strategy (n=8541) was estimated when compared with current practice (n=18,044), along with 205 fewer HBV-related deaths per 1 million infants. Immunization costs of the combination strategy were $11.5 million higher than for current practice ($108.4 million compared with $96.9 million), whereas the cost of HBV-related disease was $4.0 million lower than in current practice. The incremental cost-effectiveness ratio for the combination strategy was $17,700 per year of life saved.
Conclusion An HBV-Hib vaccine in US infants yields substantial benefits, with a cost-effectiveness ratio that is lower than that of many commonly used medical interventions.
From the Consortium for Health Outcomes, Innovation, and Cost-Effectiveness Studies and the Division of General Medicine, Department of Internal Medicine, University of Michigan School of Medicine, and the Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor (Dr Fendrick); the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Dr Fendrick and Mr Glick), and the Division of General Internal Medicine, University of Pennsylvania School of Medicine (Dr Lee and Mr Glick); and the Vaccine Division, Merck and Company, Inc, West Point, Pa (Mr LaBarge).
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