Development of recommendations for control of hepatitis B virus infections: the role of cost analysis.

Hepatitis B (HBV) infection produces a number of acute and chronic consequences including fulminant hepatitis, chronic liver disease and cirrhosis. The development of safe and effective hepatitis B vaccines has led to the development of several prevention strategies based on the endemicity and primary age of infection in the population. In areas of high endemicity of infection, universal immunization of infants has been advocated and appears feasible. However, in areas of low endemicity of infection, selected high risk group immunization of adults has been recommended but has not been successful in changing infection rates. In 1981, an analysis of the economic consequences of acute and chronic HBV-related liver disease showed an expenditure of at least US$197 million for direct medical costs and US$126 million for the associated cost of work-loss. These results suggest the more widespread use of hepatitis B vaccine to prevent these high health-related costs.