National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
PLoS One. 2023 Mar 17;18(3):e0282972. doi: 10.1371/journal.pone.0282972. eCollection 2023.
Hepatitis A virus can cause severe and prolonged illness in persons with HIV (PWH). In July 2020, the Advisory Committee on Immunization Practices (ACIP) expanded its recommendation for hepatitis A vaccination to include all PWH aged ≥1 year. We used a decision analytic model to estimate the value of vaccinating a cohort of adult PWH aged ≥20 years with diagnosed HIV in the United States using a limited societal perspective. The model compared 3 scenarios over an analytic horizon of 1 year: no vaccination, current vaccine coverage, and full vaccination. We incorporated the direct medical costs and nonmedical costs (i.e., public health costs and productivity loss). We estimated the total number of infections averted, cost to vaccinate, and incremental cost per case averted. Full implementation of the ACIP recommendation resulted in 775 to 812 fewer adult cases of hepatitis A in 1 year compared with the observed vaccination coverage. The incremental cost-effectiveness ratio for the full vaccination scenario was $48,000 for the 2-dose single-antigen hepatitis A vaccine and $130,000 for the 3-dose combination hepatitis A and hepatitis B vaccine per case averted, compared with the observed vaccination scenario. Depending on type of vaccine, full hepatitis A vaccination of PWH could lead to ≥80% reduction in the number of cases and $48,000 to $130,000 in additional cost per case averted. Data on hepatitis A health outcomes and costs specific to PWH are needed to better understand the longer-term costs and benefits of the 2020 ACIP recommendation.
甲型肝炎病毒可导致人类免疫缺陷病毒（HIV）感染者（PWH）发生严重且持久的疾病。2020 年 7 月，免疫实践咨询委员会（ACIP）扩大了甲型肝炎疫苗接种建议，将所有年龄≥1 岁的 PWH 纳入接种范围。我们使用决策分析模型，从全社会角度评估了为美国年龄≥20 岁、确诊 HIV 的成年 PWH 接种疫苗的价值。该模型比较了 3 种方案：不接种、当前疫苗接种率和完全接种。我们纳入了直接医疗成本和非医疗成本（即公共卫生成本和生产力损失）。我们估计了可预防的感染总人数、接种成本和每例可预防病例的增量成本。完全实施 ACIP 的建议，与观察到的疫苗接种率相比，1 年内可预防 775-812 例成人甲型肝炎。与观察到的疫苗接种方案相比，2 剂单价甲型肝炎疫苗和 3 剂甲型肝炎和乙型肝炎联合疫苗完全接种方案的增量成本效益比分别为每例预防病例 48000 美元和 130000 美元。根据疫苗类型的不同，对 PWH 进行完全甲型肝炎疫苗接种，可使病例数减少≥80%，每例预防病例的额外成本为 48000 美元至 130000 美元。需要针对 PWH 的甲型肝炎健康结果和成本数据，以更好地了解 2020 年 ACIP 建议的长期成本和效益。
