BACKGROUND: The incidence of hepatitis B is on the increase despite immunization of people susceptible to risk populations. After the introduction of a recombinant vaccine in 1986, it has become possible to evaluate different alternatives of immunization, from the point of view of efficacy, with the aim of controlling the disease. METHODS: A cost-effectiveness analysis was performed with the use of decision trees and calculation of the cost per avoided case of infection in the different strategies evaluated, vaccination to risk groups, pubescent youth, newborns, and communicated accidental exposure. An evaluation of the different alternatives was carried out in a simple model associated to a passive and active immunization program of newborns of mothers who are carriers of HbsAg and finally, the possibility of revaccination is added. RESULTS: Costs and future profits are presented in pesetas for 1990 and rates of social discounts of 4% and 7% are applied actualizing the same. For the prevalence estimated in the bibliography consulted, the cost per avoided case oscillated between 115,000 and 310,000 ptas in the most numerous risk groups (those living with carriers and ADVP) with lower covering; in massive immunization of pubescent youth the costs are from 30,000 to 130,000 ptas; the costs for newborns is of about 400,000 ptas; and accidental exposure rises to 500,000 ptas per avoided case. CONCLUSIONS: In vaccination versus the hepatitis B virus systematic vaccination of adolescents is proposed as most efficient and with the aim of disease control a program of passive and active immunization of newborns of carrier mothers should be included.
BACKGROUND: The incidence of hepatitis B is on the increase despite immunization of people susceptible to risk populations. After the introduction of a recombinant vaccine in 1986, it has become possible to evaluate different alternatives of immunization, from the point of view of efficacy, with the aim of controlling the disease. METHODS: A cost-effectiveness analysis was performed with the use of decision trees and calculation of the cost per avoided case of infection in the different strategies evaluated, vaccination to risk groups, pubescent youth, newborns, and communicated accidental exposure. An evaluation of the different alternatives was carried out in a simple model associated to a passive and active immunization program of newborns of mothers who are carriers of HbsAg and finally, the possibility of revaccination is added. RESULTS: Costs and future profits are presented in pesetas for 1990 and rates of social discounts of 4% and 7% are applied actualizing the same. For the prevalence estimated in the bibliography consulted, the cost per avoided case oscillated between 115,000 and 310,000 ptas in the most numerous risk groups (those living with carriers and ADVP) with lower covering; in massive immunization of pubescent youth the costs are from 30,000 to 130,000 ptas; the costs for newborns is of about 400,000 ptas; and accidental exposure rises to 500,000 ptas per avoided case. CONCLUSIONS: In vaccination versus the hepatitis B virus systematic vaccination of adolescents is proposed as most efficient and with the aim of disease control a program of passive and active immunization of newborns of carrier mothers should be included.