Economic evaluation of a publicly funded hepatitis A travel vaccination program in Ontario, Canada.

Autor: Ramsay LC; School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 1P8, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada. Electronic address: lauren.ramsay@theta.utoronto.ca., Anyiwe K; School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 1P8, Canada., Li M; East China Normal University, Zhongshan N Rd, Shanghai 3663, China., Macdonald L; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada; Public Health Ontario, 480 University Avenue, Toronto, Ontario M5G 1V2, Canada., Coyte PC; School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 1P8, Canada; Canadian Centre for Health Economics, 155 College Street, Toronto, Ontario M5T 1P8, Canada., Sander B; School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 1P8, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada; Public Health Ontario, 480 University Avenue, Toronto, Ontario M5G 1V2, Canada; Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
Jazyk: angličtina
Zdroj: Vaccine [Vaccine] 2019 Mar 07; Vol. 37 (11), pp. 1467-1475. Date of Electronic Publication: 2019 Feb 13.
DOI: 10.1016/j.vaccine.2019.01.070
Abstrakt: Background: Hepatitis A virus (HAV) causes acute liver infection and is spread through the fecal-oral route. Travel to countries in HAV-endemic regions (e.g., Asia and Latin America) is a well-described risk factor for infection. Currently, Ontario publicly funds hepatitis A vaccination for some populations at high risk of HAV infection but not for all travellers to endemic countries. The objective of this study was to determine the cost-effectiveness of expanding publicly funded HAV vaccination to people planning travel to HAV-endemic regions, from the Ontario healthcare payer perspective.
Methods: We conducted a cost-utility analysis comparing an expanded high-risk publicly-funded hepatitis A vaccination program including funded vaccine for travellers to endemic regions to the current high risk program in Ontario. A Markov state transition model was developed, including six possible health states. Model parameters were informed through targeted literature searches and included hepatitis A disease probabilities, utilities associated with health states, health system expenditures, and vaccine costs. Future costs and health outcomes were discounted at 1.5%. Primary outcomes included cost, incremental cost-effectiveness ratio (ICER) and quality adjusted life years (QALYs) over a lifetime time horizon. We conducted one-way, two-way, and probabilistic sensitivity analysis.
Results: The expanded high risk HAV vaccine program provided few incremental health gains in the travel population (mean 0.000037 QALYs/person), at an incremental cost of $124.31. The ICER of the expanded program compared to status quo is $3,391,504/QALY gained. The conclusion of the model was robust to changes in key parameters across reasonable ranges.
Conclusions: The expanded vaccination program substantially exceeds commonly accepted cost-effectiveness thresholds. Further research concerning possible cost-effective implementation of high-risk travel hepatitis A vaccination should focus on a more integrated understanding of the risk of acquiring hepatitis A during travel to endemic regions (e.g., purpose, length of stay).
(Crown Copyright © 2019. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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