Targeted outreach hepatitis B vaccination program in high-risk adults: The fundamental challenge of the last mile |
| |
| Affiliation: | 1. Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands;2. University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands;3. Public Health Service Amsterdam, Amsterdam, The Netherlands;4. Netherlands Association of Community Health Services, Utrecht, The Netherlands;5. Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands;6. Centre of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands;1. Lab of Immunoregulation, DVP, Office of Vaccines, Center for Biologics, FDA, Bldg 72, Room 1212, White Oak Campus, 10903 New Hampshire Ave., Silver Spring, MD 20993, USA;2. Human Retrovirus Pathogenesis Section, NCI Frederick, Bldg 535, Room 209, Frederick, MD 21702, USA;3. Department of Immunology and Microbial Science, IAVI Neutralizing Antibody Center and Center for HIV/AIDS Vaccine Immunology and Immunogen Discovery, The Scripps Research Institute, La Jolla, CA 92037, USA;1. Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, Food and Drug Administration, United States;2. Office of Vaccine Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, United States;1. LiteVax BV, Oss, The Netherlands;2. Biomedical Primate Research Centre, Rijswijk, The Netherlands;3. Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands;4. Viroclinics Biosciences BV, Rotterdam, The Netherlands |
| |
| Abstract: | BackgroundThe 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.MethodsBased 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.ResultsThe 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 conclusionThis 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. |
| |
| Keywords: | Hepatitis B virus vaccination High-risk group Men having sex with men Commercial sex workers Hard drug users Cost-effectiveness Economic evaluation anti-HBc" },{" #name" :" keyword" ," $" :{" id" :" k0045" }," $$" :[{" #name" :" text" ," _" :" hepatitis B core antigen CSW" },{" #name" :" keyword" ," $" :{" id" :" k0055" }," $$" :[{" #name" :" text" ," _" :" commercial sex workers HBsAg" },{" #name" :" keyword" ," $" :{" id" :" k0065" }," $$" :[{" #name" :" text" ," _" :" hepatitis B surface antigen HBV" },{" #name" :" keyword" ," $" :{" id" :" k0075" }," $$" :[{" #name" :" text" ," _" :" hepatitis B virus HDU" },{" #name" :" keyword" ," $" :{" id" :" k0085" }," $$" :[{" #name" :" text" ," _" :" hard drug users HRP" },{" #name" :" keyword" ," $" :{" id" :" k0095" }," $$" :[{" #name" :" text" ," _" :" heterosexuals with a high partner change rate ICER" },{" #name" :" keyword" ," $" :{" id" :" k0105" }," $$" :[{" #name" :" text" ," _" :" incremental cost-effectiveness ratio LYG" },{" #name" :" keyword" ," $" :{" id" :" k0115" }," $$" :[{" #name" :" text" ," _" :" life years gained MSM" },{" #name" :" keyword" ," $" :{" id" :" k0125" }," $$" :[{" #name" :" text" ," _" :" men having sex with men NIP" },{" #name" :" keyword" ," $" :{" id" :" k0135" }," $$" :[{" #name" :" text" ," _" :" national universal childhood immunisation program QALY" },{" #name" :" keyword" ," $" :{" id" :" k0145" }," $$" :[{" #name" :" text" ," _" :" quality-adjusted life year STI" },{" #name" :" keyword" ," $" :{" id" :" k0155" }," $$" :[{" #name" :" text" ," _" :" sexual-transmittable infections VE" },{" #name" :" keyword" ," $" :{" id" :" k0165" }," $$" :[{" #name" :" text" ," _" :" vaccine effectiveness |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
