Comparison of two vaccination strategies against hepatitis A and B in patients with chronic hepatitis C

Objective: although the vaccination against hepatitis A (VAH) and hepatitis B (VBH) is recommended in patients with HCV, the most cost-effective strategy has not been established. Our objective was to compare the cost-effectiveness of universal strategy (vaccination all patients) with selective strategy (vaccination only patients against virus they lack immunity to) in patients with HCV. Patients and methods: we compared the direct medical costs of the two vaccination strategies against both viruses in 313 patients with HC. Serological markers for HAV (anti-HAV) and HBV (HbsAg, anti HBs, anti HBc) were determined in the 313 patients and the costs of the vaccines and the blood tests necessary to determinate the immunity state in our care system were considered. Results: the prevalence of anti-HAV was 81.2% and of anti-HBc was 24.6%, The prevalence of anti-HAV increases with age. HAV vaccination with universal strategy has a cost of 19.806,64 (sic) and with selective one of 9.899,62. HBV vaccination with universal strategy rose to 18.780 (sic) and to 20.385,57 (sic) with selective one (employing anti-HBc). Costs were analysed in different groups of age and several hepatitis HBV risk factors. Conclusions: the selective vaccination strategy against HAV was most cost-effective in our patients with HCV. However, when the prevalence of the anti-HAV decreased to less than 20% universal strategy will be the best option. Difference of cost-effective between the two vaccination strategies against HBV was small, on behalf of universal one, so in groups with higher anti-HBc prevalence, like parenteral drugs users and tattoos, the selective strategy could be the best option.