Cost-effectiveness of hepatitis A and B vaccination programme in Germany.

A recent study in Germany analysed the epidemiological and economic impact of combined hepatitis A and hepatitis B vaccination of all 1-15-year-olds or of all 11-15-year-olds projected over three periods of 10 years compared with a strategy of non-vaccination. Vaccination of all 1-15-year-olds will achieve a reduction of 57,596 new hepatitis A cases with 7555 new infections remaining over 30 years. Vaccination of all 11-15-year-olds will reduce the number of new hepatitis A cases by 19,826, with 45,325 new cases remaining over 30 years. Vaccination of all 1-15-year-olds will reduce the number of new hepatitis B cases by 45,820 with 7484 new cases remaining over 30 years, compared with vaccination of all 11-15-year-olds, which will reduce the number of new hepatitis B cases by 21,905 with 31,339 new cases remaining over 30 years. This significant reduction in the number of new cases will lead to savings in treatment costs of DM 2.9 billion for vaccination of 11-15-year-olds and of DM 5.1 billion for vaccination of 1-15-year-olds. The cost-effectiveness of vaccination ranges from costs of DM 90,000 for each infection avoided to savings of DM 50, 000 for each case avoided. If unreported cases are also taken into account and are equally distributed between all age-groups, the savings per infection avoided over 30 years are DM 69,796 for vaccination of 11-15-year-olds and DM 55,850 for vaccination of 1-15-year-olds. Although the strategy of vaccinating 11-15-year-olds is the more cost-effective, it leaves a large percentage of the population at high risk of hepatitis A virus infection. The use of an initially more expensive combined hepatitis A and B vaccine represents a cost-effective alternative to monovalent hepatitis B vaccination and is more beneficial in terms of its epidemiological impact.