Kim Sun-Young, Billah Kaafee, Lieu Tracy A, Weinstein Milton C
Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts 02115, USA.
Am J Prev Med. 2006 Jun;30(6):498-506. doi: 10.1016/j.amepre.2006.01.017.
Despite recent significant achievements in controlling hepatitis B virus (HBV) infection, immunizing high-risk groups against the disease remains a public health challenge in the United States. The aims of this article are to evaluate the projected cost effectiveness of hepatitis B vaccination of adults attending two major types of publicly funded HIV counseling and testing sites (CTSs)-freestanding HIV CTSs and sexually transmitted disease (STD) clinics, and to compare the cost-effectiveness of alternative vaccination and testing strategies in different subgroups in this population.
A decision model was developed to determine the economic and clinical consequences, from a societal perspective, of the following strategies in two hypothetical cohorts of 100,000 adults attending each type of site: (1) routine vaccination without screening, (2) screening for antibody to hepatitis B core antigen with an initial vaccine dose during the first visit, (3) screening and vaccination based on screening results, and (4) no intervention. Life expectancy, expected quality-adjusted life years (QALYs), and medical care costs were estimated for each strategy and at each site.
Routine vaccination was both more effective and more cost-effective than either screening strategy; under base-case assumptions, routine vaccination would cost $4400 both per QALY and per life year saved. Results for STD clinics were very similar in magnitude to those for freestanding CTSs. Results were most sensitive to clients' time and travel costs for return visits and the time-discount rate.
Routine provision of hepatitis B vaccine at major HIV CTSs would be a highly effective and cost-effective approach to preventing hepatitis B among high-risk adults in the United States.
尽管近期在控制乙型肝炎病毒（HBV）感染方面取得了重大进展，但在美国，为高危人群接种该疾病疫苗仍是一项公共卫生挑战。本文旨在评估在两类主要的公共资助的HIV咨询与检测机构（CTS）——独立的HIV CTS和性传播疾病（STD）诊所就诊的成年人接种乙型肝炎疫苗的预期成本效益，并比较该人群中不同亚组的替代疫苗接种和检测策略的成本效益。
建立了一个决策模型，从社会角度确定在两个假设队列中，每组10万名在每种类型机构就诊的成年人采取以下策略的经济和临床后果：（1）不进行筛查的常规疫苗接种，（2）在首次就诊时筛查乙型肝炎核心抗原抗体并接种初始疫苗剂量，（3）根据筛查结果进行筛查和接种，（4）不进行干预。对每种策略和每个机构估计预期寿命、预期质量调整生命年（QALY）和医疗费用。
常规疫苗接种比任何一种筛查策略都更有效且更具成本效益；在基本假设下，常规疫苗接种每获得一个QALY和每挽救一个生命年的成本均为4400美元。STD诊所的结果在数量上与独立CTS的结果非常相似。结果对患者复诊的时间和交通成本以及时间贴现率最为敏感。
在美国，在主要的HIV CTS常规提供乙型肝炎疫苗将是预防高危成年人感染乙型肝炎的一种高效且具成本效益的方法。
