Economic evaluations of hepatitis B vaccination strategies - A systematic review of the literature

Abstract

National and international economic evaluations of universal vaccination against hepatitis B were systematically selected from the literature. Only the studies meeting the following criteria were selected: (a) original data reported in Dutch, English, French or German; (b) at least one universal vaccination strategy evaluated; (c) a high methodological quality shown and (d) conducting of the study in countries with a hepatitis B epidemiological pattern comparable to the Dutch situation. Sixteen relevant studies were identified out of 1060 publications registered in the databases, COCHRANE LIBRARY, CURRENT CONTENTS, DARE, HEED, INAHTA DATABASE, MEDLINE, NEED, and by applying the system of reference tracking. Despite the strict inclusion criteria, great divergence was seen among assumptions applied to a study, methodologies, outcomes and conclusions. Some studies show universal screening to be cost-saving, while others report unfavourable cost-effectiveness ratios. Studies that investigated similar vaccination strategies reach dissimilar conclusions on the most cost-effective strategy. Several parameters were found to have a usually large impact on the results and conclusions of a study. These are: a) vaccine costs, b) discount rate, c) hepatitis B incidence, d) inclusion of indirect costs and effects, e) percentage of acute infections that lead to chronic hepatitis, f) discounting effects and h) assumed lifelong costs of hepatitis B infection, including long-term consequences such as cirrhosis and liver cancer. Hence, in any further study these important variables should be subject to an extensive sensitivity analysis. Economic evaluations that are intended to assist in local policy-making should take careful account of local circumstances. The 16 selected studies have little practical relevance for Dutch policy-makers.