Keywords
Hepatitis C
vaccination
Cost-effectiveness
Economic evaluation
Systematic review
Abstract
Background. In patients who have chronic Hepatitis C virus (HCV), hepatitis A virus (HAV) infection may cause such debilitating complications as fulminant hepatitis and liver failure. This population is considered a priority group for HAV vaccination against HAV although its cost-effectiveness is still questioned. This is a systematic review to assess the cost-effectiveness of HAV vaccination against chronic HCV to guide clinical practice and the policy of the general population.
Methods. A comprehensive literature search was performed in the databases of PubMed, Scopus, Web of Science, and Embase between January 1990 and August 2024. The studies that were taken were those that determined the cost-effectiveness, cost-utility, or cost-benefit of HAV vaccination in HCV patients and reported economic consequences including incremental cost-effectiveness ratios (ICERSs), quality-adjusted life years (QALYs) or life-years saved. After surveying through the records to narrow down the potential studies to 216, the number of potential research papers had to be filtered out to the four studies which satisfied the inclusion criteria, but which did not contain any duplicates, irrelevant studies or lacked any economic assessment. Data were extracted and synthesized narratively.
Results. The included studies were conducted in the USA and Canada and used decision-analysis or Markov models to compare no vaccination, selective/screen-and-vaccinate strategies, and universal vaccination. Selective vaccination was consistently the most cost-effective strategy, with an ICER of approximately $51,000 per QALY gained in one study and cost per life-year saved ranging from $22,256 to $102,064 depending on age in another. Selective vaccination also prevented 128 symptomatic HAV cases per million population over 5 years. Universal vaccination was cost-effective only when HAV infection rates were high (>0.56% per year) or under specific cost structures, such as those of the Department of Veterans Affairs. These findings remained robust in sensitivity analyses.
Conclusion. This is because selective HAV vaccination is the most cost-effective solution in patients with chronic HCV, which happens to be more affordable in areas with low HAV prevalence. Universal immunization can be reasonably justified when the rates are high enough but care should be taken to maximize resource use. The evidence-based vaccination strategies can help to decrease the burden of HAV in this vulnerable population with the help of these findings.
References
Lei P, Hu N, Wu Y, Tang M, Lin C, Kong L, Zhang L, Luo P, Chan LWC. Radiobioinformatics: A novel bridge between basic research and clinical practice for clinical decision support in diffuse liver diseases. iRADIOLOGY 2023;1:167-89. https://doi.org/10.1002/ird3.24.
Sitnik R, Maluf MM, Oliveira KG, Siqueira RA, Ferreira C, Mangueira CLP, Azevedo RS, Ferraz M, Correa M, Ferreira PRA, Mendes Pereira GF, de Souza FMA, Pimenta C, Pinho JRR. Study protocol: epidemiological and clinical characteristics of acute viral hepatitis in Brazilian health services. BMJ Open 2021;11:e045852.https://doi.org/10.1136/bmjopen-2020-045852.
Aslam H, Oza F, Ahmed K, Kopel J, Aloysius MM, Ali A, Dahiya DS, Aziz M, Perisetti A, Goyal H. The role of red cell distribution width as a prognostic marker in chronic liver disease: a literature review. Int J Mol Sci 2023;24:3487. https://doi.org/10.3390/ijms24043487.
Shen C, Jiang X, Li M, Luo Y. Hepatitis Virus and Hepatocellular Carcinoma: Recent Advances. Cancers 2023;15:533.https://doi.org/10.3390/cancers15020533.
Almeida PH, Matielo CEL, Curvelo LA, Rocco RA, Felga G, Della Guardia B, Boteon YL. Update on the management and treatment of viral hepatitis. World J Gastroenterol 2021;27:3249-61. https://doi.org/10.1002/ird3.24.
Nelson NP, Weng MK, Hofmeister MG, Moore KL, Doshani M, Kamili S, Koneru A, Haber P, Hagan L, Romero JR, Schillie S, Harris AM. Prevention of Hepatitis A Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices, 2020. MMWR Recomm Rep 2020;69:1-38.https://doi.org/10.15585/mmwr.rr6905a1.
Ghany MG., Morgan TR. Hepatitis C Guidance 2019 Update: American Association for the Study of Liver Diseases–Infectious Diseases Society of America Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection. Hepatology 2020;71:686-721. https://doi.org/10.1002/hep.31060
Stepanova M, Younossi ZM. Economic Burden of Hepatitis C Infection. Clin Liver Dis. 2017;21:579-94. https://doi.org/10.1016/j.cld.2017.03.012.
Drabo EF, Edoka I, Padula WV. Overview of decision analysis and cost-effectiveness. Handb Health Econ 2023:140. https://doi.org/10.1093/oso/9780192896087.003.0014.
Jacobs RJ, Koff RS, Meyerhoff AS. The cost-effectiveness of vaccinating chronic hepatitis C patients against hepatitis A. Am J Gastroenterol 2002;97:427-34.https://doi.org/10.1111/j.1572-0241.2002.05481.x.
Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, Augustovski F, Briggs AH, Mauskopf J, Loder E. CHEERS Task Force. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. Value Health 2013;16:e1-5. https://doi.org/10.1016/j.jval.2013.02.010.
Arguedas MR, Heudebert GR, Fallon MB, Stinnett AA. The cost-effectiveness of hepatitis A vaccination in patients with chronic hepatitis C viral infection in the United States. Am J Gastroenterol 2002;97:721-8. https://doi.org/10.1111/j.1572-0241.2002.05554.x.
Chapko MK, Yee HS, Monto A, Dominitz JA. Cost-effectiveness of hepatitis A vaccination for individuals with chronic hepatitis C. Vaccine 2010;28:1726-31. https://doi.org/10.1016/j.vaccine.2009.12.019.
Myers R, Gregor J, Marotta P. The cost-effectiveness of hepatitis A vaccination in patients with chronic hepatitis C. Hepatology 2000;31:834-839. https://doi.org/10.1053/he.2000.5719.
Aycock R. Cost-effectiveness of hepatitis A vaccination in patients with chronic hepatitis C. Hepatology 2000;32:873;4-5. https://doi.org/10.1053/jhep.2000.18857.
Curren EJ, Shankar MB, Fischer M, Meltzer MI, Erin Staples J, Gould CV. Cost-Effectiveness and Impact of a Targeted Age- and Incidence-based West Nile Virus Vaccine Strategy. Clin Infect Dis 2021;73:1565-70. https://doi.org/10.1093/cid/ciab540.
Hassan MZ, Jubayer Biswas MAA, Shirin T, Rahman M, Chowdhury F, Azziz-Baumgartner E, Davis WW, Hussain M. Cost-effectiveness of seasonal influenza vaccination in WHO-defined high-risk populations in Bangladesh. J Glob Health 2024;14:04126. https://doi.org/10.7189/jogh.14.04126.
Krahn MD, John-Baptiste A, Yi Q, Doria A, Remis RS, Ritvo P, Friedman S. Potential cost-effectiveness of a preventive hepatitis C vaccine in high risk and average risk populations in Canada. Vaccine 2005;23:1549-58. https://doi.org/10.1016/j.vaccine.2004.09.023.
Raviotta JM, Smith KJ, DePasse J, Brown ST, Shim E, Nowalk MP, Wateska A, France GS, Zimmerman RK. Cost-effectiveness and public health impact of alternative influenza vaccination strategies in high-risk adults. Vaccine 2017;35:5708-13. https://doi.org/10.1016/j.vaccine.2017.07.069.