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HEPATITIS B VACCINATION COSTS $33 VERSUS TREATMENT COSTS OF $69.46

Executive Summary

HEPATITIS B VACCINATION COSTS $33 VERSUS TREATMENT COSTS OF $69.46 for infants born to hepatitis B positive women, according to a cost-benefit analysis conducted by Washington, D.C-based Battelle Human Affairs Research Center for the Centers for Disease Control. The analysis was presented to CDC's Immunization Practices Advisory Committee by Harold Margolis, chief of CDC's hepatitis branch, at an Oct. 15-16 meeting in Atlanta, Georgia. The committee is charged with advising HHS and the director of the CDC on immunization policy. CDC requested the cost-benefit analysis as part of an ongoing examination of its proposed universal childhood hepatitis B immunization program. Currently, only pregnant women and infants living in populations with a high incidence of infection -- including Alaskan natives, Pacific Islanders and infants of Asian mothers -- receive routine screening and immunization funded by various federal agencies, including the Indian Health Service and the CDC. Congress appropriated approximately $9.9 mil. in 1990 to the CDC's immunization program, Margolis noted. Those funds "cover approximately 75% of the target public sector population [but] there currently are no funds for immunization of infants born to Asian mothers." According to CDC's cost benefit analysis, a universal childhood hepatitis B immunization program would cost the public sector $105 mil. per birth cohort compared to $385 mil. per cohort if no such program were in place. Of the $105 mil. total, CDC said the immunization program would cost $8.6 mil. per year in direct medical costs, $34 mil. in indirect productivity and $61.9 mil. in screening and vaccination costs. In contrast, the absence of a comprehensive immunization program would cost $71.8 mil. in direct costs and $313.8 mil. in indirect productivity. The high cost, Margolis stated, "is really the cost of chronic liver disease from hepatitis B." Although evidence supports a universal vaccine program, Margolis noted that there are longstanding problems to be addressed before a program can be put into place. For example, he said an approved, flexible dose schedule must be developed; a recommended number of injections per child, including booster shots, must be determined; combined antigen preparations, such as a pertussis-hepatitis B combination, must be developed; and a definition of liability for adverse events related to the vaccine must be established. Stanley Plotkin, American Association of Pediatrics, said he "would be in favor of pilot studies...to give us confidence to go ahead" with the immunization program. However, Plotkin added that he had "lingering concerns on persistence of immunity." As proposed, the pilot studies would look at the feasibility of universal immunization. Margolis noted that Alaska already has a universal immunization program in place, while Hawaii is considering such a program. Committee chairman Samuel Katz, Duke University Medical Center, concluded that "the committee would be supportive of going ahead with...studies with the expectation that a major program could develop." The committee also voted to revise its statement on pertussis vaccination to state: "A causal relationship between DTP vaccine and brain damage has not been proven. If the vaccine [causes brain damage], it must be exceedingly rare." The revised statement adds that "the risk estimate of 1:140,000 for serious acute neurological illness and 1:1330,000 for brain damage should no longer be used." The revised statement will be published in CDC's Morbidity and Mortality Weekly Report. The revisions are based on a 10-year follow-up of the British epidemiologic study, the National Childhood Encephalopathy Study, and several other studies. They also follow the conclusions of a January 1990 meeting of the Institute of Medicine's Committee to Review the Adverse Consequences of Pertussis and Rubella Vaccines ("The Pink Sheet" Jan. 15, T&G-7). The IoM committee is to issue a report in May 1991.
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