Targeted outreach hepatitis B vaccination program in high-risk adults: The fundamental challenge of the last mile

Vaccine. 2017 May 31;35(24):3215-3221. doi: 10.1016/j.vaccine.2017.04.068. Epub 2017 May 5.

Abstract

Background: The 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.

Methods: Based 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.

Results: The 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 conclusion: This 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: Commercial sex workers; Cost-effectiveness; Economic evaluation; Hard drug users; Hepatitis B virus vaccination; High-risk group; Men having sex with men.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Community-Institutional Relations / economics
  • Cost-Benefit Analysis
  • Female
  • Health Care Costs
  • Hepatitis B / epidemiology
  • Hepatitis B / prevention & control*
  • Hepatitis B / virology
  • Hepatitis B Vaccines / administration & dosage*
  • Heterosexuality
  • Humans
  • Immunization Programs / economics*
  • Male
  • Netherlands / epidemiology
  • Public Health / economics
  • Quality-Adjusted Life Years
  • Risk-Taking*
  • Sex Workers

Substances

  • Hepatitis B Vaccines