Prevention of hepatitis B virus transmission by immunization. An economic analysis of current recommendations

JAMA. 1995 Oct 18;274(15):1201-8.


Objective: To evaluate the outcome of immunization strategies to prevent hepatitis B virus (HBV) transmission.

Design and setting: A decision model was used to determine the incremental effects of the following hepatitis B immunization strategies in a birth cohort receiving immunization services in the public sector: (1) prevention of perinatal HBV infection, (2) routine infant vaccination, or (3) routine adolescent vaccination.

Main outcome measures: Over the lifetime of the cohort, the reduction in infections and medical and work-loss costs of HBV-related liver disease were determined for each strategy and compared with the outcome without immunization.

Results: Prevention of perinatal infection and routine infant vaccination would lower the 4.8% lifetime risk of HBV infection by at least 68%, compared with a 45% reduction for adolescent vaccination. From a societal perspective, each strategy was found to be cost saving, but was not cost saving with respect to direct medical costs. The estimated cost per year of life saved was $164 to prevent perinatal HBV infection, $1522 for infant vaccination, and $3730 for adolescent vaccination.

Conclusions: Routine vaccination of infants in successive birth cohorts to prevent HBV transmission is cost-effective over a wide range of assumptions. While economically less attractive than infant vaccination, adolescent vaccination could serve to protect those children who were not vaccinated as infants.

MeSH terms

  • Adolescent
  • Age Factors
  • Child
  • Child, Preschool
  • Costs and Cost Analysis
  • Decision Trees
  • Female
  • Hepatitis B / economics
  • Hepatitis B / prevention & control*
  • Hepatitis B / transmission
  • Hepatitis B Vaccines / administration & dosage*
  • Hepatitis B Vaccines / economics
  • Humans
  • Immunization Programs / economics*
  • Immunization Schedule
  • Infant
  • Infant, Newborn
  • Infectious Disease Transmission, Vertical / prevention & control
  • Male
  • Pregnancy
  • Program Evaluation
  • Risk Factors
  • United States
  • Vaccination / economics
  • Vaccination / standards*


  • Hepatitis B Vaccines