Cost-utility of universal hepatitis A vaccination in Canada

Abstract

Hepatitis A (HA) vaccination in Canada is currently targeted toward high-risk groups. The cost-effectiveness and expected health outcomes of universal vaccination relative to targeted vaccination in low-incidence countries such as Canada are currently unknown. Here, we conducted a cost-utility analysis for this situation, with Canada as the study population. We included vaccine costs, time costs, and public health costs. We assessed a range of possible universal vaccination strategies over an 80-year time horizon using multiple cost perspectives. A dynamic model was used to account for herd immunity. Aggregate health gains from switching to universal vaccination are modest (10-30 QALYs per year). However, a 9+9" strategy that replaces two doses of hepatitis B (HB) vaccine at 9/10 years (universally administered in most provinces) with two doses of bivalent HA/HB vaccine is cost-saving from the societal perspective. At a willingness to pay threshold of $50 000/QALY mean net benefit is +49.4 QALYs (SD 12.6) from the societal perspective and +3.8 QALYS (SD 3.0) from the payer perspective. Net benefit from the payer perspective is sensitive to the marginal cost of bivalent HA/HB vaccine relative to monovalent HB vaccine. Similar conclusions may apply in other countries with low incidence and a current targeted policy.