Economic Evaluation of Delivering Hepatitis B Vaccine to Injection Drug Users
Background
Injection drug users (IDUs) are at high risk of hepatitis B (HBV) infection, and hepatitis B vaccination coverage in IDUs is low. Recent studies demonstrate that syringe exchange programs are effective venues to reach and immunize IDUs. The purpose of this paper was to determine if targeting IDUs for HBV vaccination through syringe exchange programs is economically desirable for the healthcare system and to assess the relative effectiveness of several different vaccination strategies.
Methods
Active IDUs in Chicago IL and Hartford and Bridgeport CT (N=1964) were recruited and screened through local syringe exchange programs, randomized to a standard (0, 1, 6 months) or accelerated (0, 1, 2 months) vaccination schedule, and followed from May 2003 to March 2006. Analyses were conducted in 2007. The vaccination program's costs were balanced against future HBV-associated medical costs. Benefits in terms of prevented acute HBV infections and quality-adjusted life years were estimated based on a Markov model.
Results
HBV vaccination campaigns targeting IDUs through syringe exchange programs are cost-saving. The most cost-saving strategies include giving the first dose to everyone at screening, administering the vaccination under the accelerated schedule (0, 1, 2 months), and obtaining highly discounted vaccine from local health departments.
Conclusions
It is economically inappropriate to offer HBV screening in the absence of vaccination. Existing syringe exchange programs in the U.S. should include HBV vaccination.
aDepartment of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut
bCenter for Health, Intervention and Prevention (CHIP), University of Connecticut, Hartford, Connecticut
cDepartment of Sociology, DePaul University, Chicago, Illinois
dDepartment of Medicine, University of California San Francisco, San Francisco VA Medical Center General Internal Medicine, San Francisco, California
eDepartment of Bioethics, Case Western Reserve University, Cleveland, Ohio
Address correspondence and reprint requests to: Yiqing Hu, MPhil, Department of Epidemiology and Public Health, Yale University School of Medicine, P.O. Box 208034, 60 College Street, New Haven CT 06520-8034.
ABSTRACT