The cost-effectiveness of hepatitis B vaccine.

We evaluated the cost-effectiveness of different strategies for use of hepatitis B vaccine. For populations with high prevalences of immunity and high attack rates, screening for prior immunity and vaccinating susceptibles is the lowest cost strategy. For populations with low prevalences of immunity but with high attack rates, vaccination without screening is most cost-saving. For populations with low prevalences of immunity and low attack rates, a non-vaccination policy is least costly. Vaccination will be cost-saving for populations with annual attack rates of five per cent, if direct medical costs only are considered or, for populations with annual attack rates on the order of one per cent, if indirect medical costs are included.