Cost-effectiveness of different strategies for prevention of congenital rubella infection: a practical example from Iceland.

Cost-benefit analyses show that prevention of congenital rubella infection is cost-effective. Before selection of a strategy, local epidemiologic and social factors need examination. Analyzing these factors may lead to considerable cost reduction, especially if results from preexisting screening programs are available. The cost-effectiveness of different strategies are compared in Iceland. Systematic screening of women and teenage girls, with vaccination of seronegative persons, was more cost-effective than vaccination of all children. Previously unscreened females aged 12-40 years were screened and seronegative females were vaccinated for one-third the cost of vaccinating all children aged two to 12 years. Continuation of this program by vaccinating 12-year-old girls was two to three times more cost-effective than vaccination of all two-year-old children. Use of rubella vaccine in combined vaccines proved the most expensive strategy, with or without revaccination of teenagers.