Cost effectiveness of hepatitis B vaccination at HIV counseling and testing sites
Cost effectiveness of hepatitis B vaccination at HIV counseling and testing sites
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DOI：
10.1016/j.amepre.2006.01.017
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发表时间：
2006-06-01
影响因子：
5.5
通讯作者：
Weinstein, Milton C.
中科院分区：
文献类型：
--
作者：
Kim, Sun-Young;Billah, Kaafee;Weinstein, Milton C.
背景资料：尽管最近在控制B型肝炎病毒（HBV）感染方面取得了重大成就，但对高危人群进行免疫接种仍然是美国的公共卫生挑战。本文的目的是评估参加两种主要类型的公共资助的艾滋病毒咨询和检测站点（CTS）-独立的艾滋病毒CTS和性传播疾病（STD）诊所的成人的B型肝炎疫苗接种的预计成本效益，并比较该人群中不同亚组的替代疫苗接种和检测策略的成本效益。方法：开发了一个决策模型，以确定从社会角度来看，在两个假设的100，000名成年人参加每种类型的网站的队列中，以下策略的经济和临床后果：（1）常规接种，不进行筛查;（2）首次访视时以初始疫苗剂量进行乙肝B核心抗原抗体筛查;（3）根据筛查结果进行筛查和接种;（4）不进行干预。预期寿命，预期质量调整生命年（QALY），和医疗保健成本估计为每个战略，并在每个site.Results：常规疫苗接种是更有效的，更符合成本效益比任何筛查策略，根据基本情况的假设，常规疫苗接种将花费4400美元每QALY和每个生命年保存。STD诊所的结果与独立CTS的结果在幅度上非常相似。结果是最敏感的客户的时间和旅行成本回访和时间折扣率。结论：常规提供B疫苗在主要的艾滋病毒CTSs将是一个非常有效的和具有成本效益的方法，以防止B在美国的高危成人。
Background: Despite recent significant achievements in controlling hepatitis B virus (HBV) infection, immunizing high-risk groups against the disease remains a public health challenge in the United States. The aims of this article are to evaluate the projected cost effectiveness of hepatitis B vaccination of adults attending two major types of publicly funded HIV counseling and testing sites (CTSs)-freestanding HIV CTSs and sexually transmitted disease (STD) clinics, and to compare the cost-effectiveness of alternative vaccination and testing strategies in different subgroups in this population.Methods: A decision model was developed to determine the economic and clinical consequences, from a societal perspective, of the following strategies in two hypothetical cohorts of 100,000 adults attending each type of site: (1) routine vaccination without screening, (2) screening for antibody to hepatitis B core antigen with an initial vaccine dose during the first visit, (3) screening and vaccination based on screening results, and (4) no intervention. Life expectancy, expected quality-adjusted life years (QALYs), and medical care costs were estimated for each strategy and at each site.Results: Routine vaccination was both more effective and more cost-effective than either screening strategy; under base-case assumptions, routine vaccination would cost $4400 both per QALY and per life year saved. Results for STD clinics were very similar in magnitude to those for freestanding CTSs. Results were most sensitive to clients' time and travel costs for return visits and the time-discount rate.Conclusions: Routine provision of hepatitis B vaccine at major HIV CTSs would be a highly effective and cost-effective approach to preventing hepatitis B among high-risk adults in the United States.