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The European Journal of Public Health Advance Access originally published online on December 26, 2007
The European Journal of Public Health 2008 18(3):275-282; doi:10.1093/eurpub/ckm123
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© The Author 2007. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Infant, Child and Adolescent Health

Cost effectiveness of hepatitis B vaccination strategies in Ireland: an economic evaluation

Lesley Tilson1, Lelia Thornton2, Darina O’Flanagan2, Howard Johnson3 and Michael Barry1

1 National Centre for Pharmacoeconomics, St James's University Teaching Hospital, James's St, Dublin 8, Ireland
2 Health Protection Surveillance Centre, Health Service Executive, 25 Middle Gardiner St, Dublin 1, Ireland
3 National Population Health Directorate, Health Service Executive, Dr Stevens Hospital, Dublin 8, Ireland

Correspondence: Lesley Tilson, National Centre for Pharmacoeconomics, St James's University Teaching Hospital, James's St, Dublin 8, Ireland, tel: +353 1 4103427, fax: +353 1 4730596, email: ltilson{at}stjames.ie

Received March 12, 2007 , accepted November 14, 2007

Background: In accordance with World Health Organization recommendations, many European countries have introduced universal hepatitis B vaccination policies. The UK and Ireland are exceptions. In this study, we conducted an economic evaluation of a universal infant hepatitis B vaccination programme, using a six-component vaccine, compared with the current selective strategy of vaccinating high-risk infants with a monovalent hepatitis B vaccine. Methods: A cost effectiveness analysis was conducted using a Markov model. The perspective of the analysis was the Irish Health Service Executive. Unit cost and resource utilization data were derived from expert clinical opinion, published sources, diagnosis-related group costs for hospital admissions and local cost estimates for medical fees and laboratory investigations. A full probabilistic sensitivity analysis was undertaken. Both costs and outcomes were modelled over a period of 80 years and discounted at 3.5%. Results: Assuming an incidence of acute hepatitis B virus (HBV) infection in Ireland of 8.4 per 100 000 population, the incremental cost effectiveness ratio ranged from {euro}10 992/life years gained (LYG) to {euro}67 200/LYG, at the lowest and highest price estimates for the six-component vaccine, respectively. The cost effectiveness of universal versus selective hepatitis B vaccination was sensitive to the risk of acute HBV infection, the cost of the universal infant vaccination programme and the discount rate. Conclusion: At a cost of {euro}29.00 per dose of the six-component vaccine, universal infant hepatitis B vaccination is cost effective at {euro}37 018/LYG. This compares favourably with other preventive programmes in Ireland.

Keywords: cost-effectiveness, economic, hepatitis B, Ireland, vaccination


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