Economic evaluations applied to HB vaccination: general observations.

Since HB vaccines became available, there have been many economic evaluations on HB vaccination programs. The majority of them were for countries of low endemicity. Economic evaluations for countries of very low endemicity with a good surveillance system in place and high attendance of Sexually Transmitted Disease- and Intra VenousDrug Users-clinics indicate that risk group vaccination is the most cost-effective strategy to control HB. In analyses for low endemic countries, recommendations have shifted from risk group vaccination in the eighties to universal vaccination of either infants or adolescents in the nineties. For the health care payer, the resulting cost-effectiveness ratios of universal vaccination were favourable in comparison to those of other preventive interventions. From a societal point of view, universal HB vaccination was found to be cost-saving in these countries. Few published studies were set in countries of intermediate to high endemicity. They indicate that for the health care payer universal HB vaccination of neonates or infants is cost-effective compared to other interventions, or even cost-saving. Further studies are needed to support decision making in high endemic countries, where both the need for HB vaccination and the pressure on resources are highest.