The impact of assumptions regarding vaccine-induced immunity on the public health and cost-effectiveness of hepatitis A vaccination: Is one dose sufficient?

Hum Vaccin Immunother. 2016 Nov;12(11):2765-2771. doi: 10.1080/21645515.2016.1203495. Epub 2016 Jul 18.


Hepatitis A vaccination stimulates memory cells to produce an anamnestic response. In this study, we used a mathematical model to examine how long-term immune memory might convey additional protection against clinical/icteric infections. Dynamic and decision models were used to estimate the expected number of cases, and the costs and quality-adjusted life-years (QALYs), respectively. Several scenarios were explored by assuming: (1) varying duration of vaccine-induced immune memory, (2) and/or varying levels of vaccine-induced immune memory protection (IMP), (3) and/or varying levels of infectiousness in vaccinated individuals with IMP. The base case analysis assumed a time horizon of 25 y (2012 - 2036), with additional analyses over 50 and 75 y. The analyses were conducted in the Mexican public health system perspective. In the base case that assumed no vaccine-induced IMP, the 2-dose hepatitis A vaccination strategy was cost-effective compared with the 1-dose strategy over the 3 time horizons. However, it was not cost-effective if we assumed additional IMP durations of at least 10 y in the 25-y horizon. In the 50- and 75-y horizons, the 2-dose strategy was always cost-effective, except when 100% reduction in the probability of icteric Infections, 75% reduction in infectiousness, and mean durations of IMP of at least 50 y were assumed. This analysis indicates that routine vaccination of toddlers against hepatitis A virus would be cost-effective in Mexico using a single-dose vaccination strategy. However, the cost-effectiveness of a second dose depends on the assumptions of additional protection by IMP and the time horizon over which the analysis is performed.

Keywords: Immune memory; cost-effectiveness; hepatitis A; mathematical model; number of doses; vaccination.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Cost-Benefit Analysis*
  • Female
  • Hepatitis A / economics
  • Hepatitis A / epidemiology*
  • Hepatitis A / prevention & control*
  • Hepatitis A Vaccines / administration & dosage*
  • Hepatitis A Vaccines / economics
  • Hepatitis A Vaccines / immunology*
  • Humans
  • Male
  • Mexico / epidemiology
  • Models, Theoretical
  • Quality-Adjusted Life Years
  • Young Adult


  • Hepatitis A Vaccines