Cost-benefit analysis of two strategies for prevention of Haemophilus influenzae type b infection.

A cost-benefit analysis for Haemophilus influenzae type b disease prevention was developed to examine two officially recommended preventive strategies: H influenzae type b capsular polysaccharide immunization and rifampin prophylaxis of exposed contacts. The social costs of H influenzae type b disease in the 1984 US birth cohort will be $1.937 billion when base case assumptions are made. If it is assumed that 60% of all children could be vaccinated at 24 months of age, universal vaccination has the highest economic benefits of any single preventive strategy considered (net savings $64.8 million). Rifampin prophylaxis of appropriate household contacts has the highest benefit to cost ratio (59:1), but because rifampin prevents only secondary disease, only half as many cases can be prevented with rifampin prophylaxis of appropriate household contacts (501 cases prevented, $1,994 per case prevented) as with universal vaccination at 24 months (985 cases prevented, $63,484 per case prevented). Single-dose vaccination of day-care attendees at 18 months of age is the most expensive preventive strategy considered ($148,445 per case prevented, 306 cases prevented). Rifampin prophylaxis of appropriate day-care contacts prevents the fewest H influenzae type b cases ($46,041 per case prevented, 72 cases prevented.