Primary high-dose intradermal hepatitis B vaccination in hemodialysis: cost-effectiveness evaluation at 2 years.

Reinforced hepatitis B (HB) vaccination schedules have been tested in nonresponsive hemodialysis (HD) patients. Primary high-dose intradermal (ID) vaccination in HD has been proposed in one study with higher seroconversion rate, but no cost analysis was made. The aim of this prospective study was to confirm this previous report and focus on a cost-effectiveness evaluation of the thorough vaccination with a maintenance program. Thirty-five chronic incident HD patients received primary ID HB vaccination with a reinforced schedule (20 microg Engerix-B every 2 weeks). Revaccination with a monthly single ID dose of 20 microg was performed whenever anti-HBs titer fell under 20 IU/L and continued until a titer of 20 U/L was reached. Outcome measures were cumulative seroconversion rates, mean levels of anti-HBs, maintenance booster doses, rate of seroprotection at the end of the 2-year follow-up and subsequent costs. The present study was associated with an earlier peak of anti-HBs titer (3.9+/-1.7 months) and a higher cumulative seroconversion rate (96.9%) after 1 year. Moreover, a low-booster shot (17.4 microg) of ID Engerix-B/year/patient confers a 100% seroprotection for all responders for a second-year period. The mean cost of our schedule is 127.7 euro/patient for a 2-year period, revaccination included. This current study demonstrates that primary reinforced ID HB vaccination with a maintenance program for a 2-year period warrants the best cost-effectiveness ratio with rapid and sustained seroprotection in almost all HD patients.