The Denver school-based adolescent hepatitis B vaccination program: a cost analysis with risk simulation

Am J Public Health. 1999 Nov;89(11):1722-7. doi: 10.2105/ajph.89.11.1722.


Objectives: This study sought to compare the cost-effectiveness of a school-based hepatitis B vaccine delivery program with that of a vaccine delivery program associated with a network health maintenance organization (HMO).

Methods: The vaccination program enrolled 3359 sixth-grade students from 18 middle schools in Denver, Colo. Immunization status and direct and indirect program costs were compiled. The sensitivity of the outcomes was assessed by simulation methods.

Results: The per-dose cost-effectiveness ratio for the school-based delivery system was $31. This cost-effectiveness ratio remained stable when the model was simulated with costs that were underestimated or overestimated by 20%. In the network HMO, the direct cost per dose was $68 and the societal cost was $118 when the child's father worked full-time and the mother worked part-time. There is less than a 5% chance that the network HMO-based vaccination program could be more cost-effective than the school-based program.

Conclusions: The cost per dose of the school-based program was significantly less than that of the network HMO-based program, because in the school program government-purchased vaccine was available at a lower cost and parents did not incur work-loss costs.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Colorado
  • Cost of Illness
  • Cost-Benefit Analysis
  • Female
  • Health Maintenance Organizations / economics*
  • Hepatitis B / economics*
  • Hepatitis B / prevention & control
  • Hepatitis B Vaccines / administration & dosage
  • Hepatitis B Vaccines / economics*
  • Humans
  • Male
  • Models, Statistical
  • Program Evaluation
  • Risk
  • School Health Services / economics*


  • Hepatitis B Vaccines