Testing for antibody to hepatitis A to decrease the cost of hepatitis A prophylaxis with immune globulin or hepatitis A vaccines

Arch Intern Med. 1994 Mar 28;154(6):663-8.


Background: The introduction of new vaccines to prevent hepatitis A infection raises the question of the cost of these vaccines relative to immune globulin when short-term protection against hepatitis A is required. Since the prevalence of hepatitis A antibodies (anti-HAV) in the US population increases rapidly with age, testing for anti-HAV may decrease the cost of vaccination programs.

Methods: A cost-analysis model was developed that incorporates the cost of immune globulin or hepatitis A vaccine, the number of doses of vaccine, the cost of testing for anti-HAV in either commercial or public-sector laboratories, and the prevalence of anti-HAV in the general population by age.

Results: In comparison with hepatitis A vaccines, with expected costs between $10 and $25 per dose, use of immune globulin for postexposure prophylaxis or preexposure short-term (< or = 6 months) prophylaxis is much less expensive for all age groups. Testing for anti-HAV does not significantly diminish the cost of immune globulin regimens. In contrast, if anti-HAV testing is performed in a public-sector laboratory at $10 per test, and hepatitis A vaccine costs $10 per dose, testing reduces vaccination costs in those 40 years of age or older for a two-dose vaccine regimen and in those 30 years of age or older for a three-dose regimen. At the other end of the spectrum, if vaccine costs $35 per dose, commercial testing for anti-HAV at $25 per person reduces the costs in those 30 years of age or older if either a two- or three-dose regimen is elected. However, vaccine savings are realized in those 10 years and older if public-sector testing is performed and three doses of vaccine at $35 per dose are utilized. In an intermediate scenario of public-sector testing and vaccines costing $25 per dose, the cost would also be reduced in those 30 years old or older.

Conclusions: Testing for anti-HAV in frequent travelers, international government, business, and volunteer workers, military personnel, etc, may be an effective means of decreasing costs of hepatitis A prevention.

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Cost-Benefit Analysis
  • Drug Costs
  • Female
  • Hepatitis A / economics
  • Hepatitis A / immunology*
  • Hepatitis A / prevention & control
  • Hepatitis A Vaccines
  • Hepatitis Antibodies / blood*
  • Humans
  • Immunoglobulins / economics*
  • Immunoglobulins / therapeutic use
  • Male
  • Middle Aged
  • Travel / economics
  • United States
  • Viral Hepatitis Vaccines / economics*


  • Hepatitis A Vaccines
  • Hepatitis Antibodies
  • Immunoglobulins
  • Viral Hepatitis Vaccines