Hepatitis B prevention in Europe: a preliminary economic evaluation

The World Health Organization (WHO) estimates that about 350 million people in the world are carriers of the hepatitis B virus (HBV), 60 million of whom may die from liver cancer and about 45 million from cirrhosis. In the WHO European Region, which has a total population of 839 million inhabitants, the average number of acute hepatitis B cases reported in 1991 was approximately 160 000, giving an incidence of 19 per 100 000 population. This incidence rate varies from 5 per 100 000 in western Europe to 22 per 100 000 in central Europe and 92 per 100 000 in eastern Europe. Because of under-reporting and the fact that two-thirds of infections are asymptomatic, the reported incidence rate considerably underestimates the true incidence of HBV in Europe. For this reason, we may multiply the number of reported cases by a factor of 6 (by 2 for under-reporting and by 3 for the symptomatic/asymptomatic ratio): an estimated 900 000 to 1 000 000 infections of HBV occur in Europe each year. Approximately 90 000 chronic infections will develop from these new cases. The spread of HBV can be controlled by universal infant or adolescent vaccination. A decision-tree-based analytical model was used to assess the clinical and economic impact of these two interventions. The model took into account incidence and prevalence rates of HBV, natural history of infection, compliance and effectiveness of vaccination, and direct and indirect costs. Data were obtained from the literature and from a WHO European survey. The cost-effectiveness ratio amounts to £6443 and £4745 per infection prevented for neonatal and adolescent vaccination, respectively. The results from these calculations show that neither vaccination of neonates or of adolescents is cost-saving. However, the cost-effectiveness - i.e. the cost incurred to prevent an HBV infection is of an acceptable magnitude for both strategies.

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