Vaccine
Volume 30, Issue 42, Pages 6007-6110 (14 September 2012)
http://www.sciencedirect.com/science/journal/0264410X/30/42

Cost-effectiveness of hepatitis A vaccination for adults in Belgium
Original Research Article
Pages 6070-6080
Jeroen Luyten, Stefaan Van de Sande, Koen de Schrijver, Pierre Van Damme, Philippe Beutels

Abstract
Hepatitis A vaccination targeting adults (or adult risk-groups like e.g. travellers, health care workers, soldiers or teachers) could be considered an alternative to a universal infant or adolescent vaccination program in low endemic countries. We estimated the current disease burden of hepatitis A in Belgium, and evaluated whether adult vaccination is cost-effective. We used a Markov cohort model to simulate the costs and effects of (1) vaccination of adults and (2) serological screening of adults and vaccination of susceptibles and compared these with the current situation. The results indicated that these expanded vaccination strategies are not cost-effective in the epidemiological circumstances of a typical low-endemic western country. In order to gain 1 quality-adjusted life year the health care payer would have to pay 185,000€ for vaccination and 223,000€ for screening and vaccination of seronegatives. For adult vaccination to be cost-effective, risk-groups would need to be exposed to a force of infection that is 3.5–4 times higher than currently estimated in the general population; or the total costs of vaccination would have to drop with approximately 75%.