The Economics of Hepatitis B Virus Vaccination An Analysis of Cost-Effectiveness Results for Switzerland Pascal Zurn, 1 Guy Carrin, 2 Jean-Pierre Danthine, 1 Raoul Kammerlander 3 and Mark Kane 2 1 University of Lausanne, Lausanne, Switzerland 2 World Health Organization, Geneva, Switzerland 3 Swiss Federal Office of Public Health, Bern, Switzerland Abstract Objective: To assess and compare the costs and effectiveness of different vacci- nation strategies against hepatitis B in Switzerland. Design: A birth cohort of 85 000 individuals was followed over their lifetime, using a decision-tree analysis. Published data were used to simulate the risk of hepatitis B virus (HBV) infection in the cohort, the consecutive clinical outcomes and the associated costs. Five new vaccination scenarios were assessed and com- pared with a baseline strategy of vaccination of high-risk groups. The 5 new vaccination scenarios were: (i) systematic prenatal screening and vaccination of newborns at risk; (ii) universal vaccination of infants; (iii) universal vaccination of school children; (iv) universal vaccination of infants and school children; and (v) universal vaccination of infants, school children and adolescents. Results: The incremental cost per year of life saved for systematic prenatal screening and vaccination of newborns at risk compared with the baseline sce- nario was estimated to be 23 350 Swiss francs (SwF; 1996 values). The 4 univer- sal vaccination scenarios had a much larger impact on the number of chronic infections and deaths prevented. The incremental cost per year of life saved for universal vaccination compared with systematic prenatal screening and vaccina- tion of newborns at risk ranged from SwF6120 (infant vaccination strategy) to SwF10 200 (school children vaccination strategy). In the sensitivity analysis, prevalence, vaccine price and discount rate were key elements. Conclusion: Incremental cost-effectiveness ratios are lower with universal vac- cination strategies than with selective vaccination. Furthermore, with universal vaccination strategies, increasingly ambitious strategies result in higher costs but also in more incremental years of life saved. ORIGINAL RESEARCH ARTICLE Dis Manage Health Outcomes 2000 Jun; 7 (6): 331-347 1173-8790/00/0006-0331/$20.00/0 © Adis International Limited. All rights reserved. Hepatitis B virus (HBV) infection is one of the world’s major health problems, with more than 300 million carriers estimated worldwide. HBV is an important cause of primary liver cancers in devel- oping countries (up to 80%). The prevalence of chronic carriers of HBV varies widely throughout the world. It ranges from over 8% in highly endemic countries in Asia, Africa, Pacific Islands and the Arctic to below 2% in countries with low endemic- ity such as Western Europe and North America. Countries with intermediate endemicity such as Southern and Eastern Europe and Israel have rates between 2 and 7%. In Switzerland, the prevalence of chronic carriers is estimated at about 3 per thousand