Published online January 2, 2007
PEDIATRICS Vol. 119 No. 1 January 2007, pp. e22-e29 (doi:10.1542/peds.2006-1572)
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ARTICLE

The Economics of Routine Childhood Hepatitis A Immunization in the United States: The Impact of Herd Immunity

Gregory L. Armstrong, MDa, Kaafee Billah, PhDa,{dagger}, David B. Rein, PhDb, Katherine A. Hicks, MSb, Kathleen E. Wirth, BAb and Beth P. Bell, MD, MPHa

a Division of Viral Hepatitis, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
b RTI International, Atlanta, Georgia

OBJECTIVES. Because of the herd-immunity phenomenon, the benefits of immunization against hepatitis A extend beyond those received by those who are vaccinated. This analysis estimates the impact of herd immunity on the cost-effectiveness of routine hepatitis A immunization among US children.

PATITENS AND METHODS. In an economic model, the costs and benefits of hepatitis A immunization were estimated for immunizing all US children at age 1 year over a 10-year period starting in 2005. The future burden of disease from hepatitis A was also estimated with this model, and the fraction that would be prevented by herd immunity was modeled by using a previously published analysis of the relationship between hepatitis A vaccination coverage and declines in hepatitis A incidence.

RESULTS. Without accounting for herd-immunity effects, the costs of routine immunization would average $32000 per quality-adjusted life-year gained for the first 10 cohorts immunized starting with the 2005 birth cohort. Herd-immunity effects would be expected to produce substantial additional benefits, lowering the cost of the immunization program to $1000 per quality-adjusted life-year gained for the first 10 cohorts. Herd-immunity benefits would be greatest for the first few cohorts, more than doubling the benefits of immunization, and would decline over time. In a univariate sensitivity analysis, estimates were most sensitive to vaccination costs but remained below $20000 per quality-adjusted life-year under all of the assumptions.

CONCLUSIONS. Herd-immunity effects more than double the savings from hepatitis A immunization during the first 10 years of the program. After accounting for these effects, immunization is close to cost-neutral on a cost-per-quality-adjusted-life-year basis.

Key Words: hepatitis A vaccines • cost-effectiveness • herd immunity

Abbreviations: HAV—hepatitis A virus • ACIP—Advisory Committee on Immunization Practices • LY—life-year • QALY—quality-adjusted life-year

Accepted Aug 16, 2006.




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