IS TRAVEL PROPHYLAXIS WORTH WHILE - ECONOMIC APPRAISAL OF PROPHYLACTIC MEASURES AGAINST MALARIA, HEPATITIS-A, AND TYPHOID IN TRAVELERS

Objectives-To estimate the costs and benefits of prophylaxis against travel acquired malaria, typhoid fever, and hepatitis A in United Kingdom residents during 1991. Design-Retrospective analysis of national epidemiological and economic data. Main outcome measures-Incidence of travel associated infections in susceptible United Kingdom residents per visit; costs of prophylaxis provision from historical data; benefits to the health sector, community, and individuals in terms of avoided morbidity and mortality based on hospital and community costs of disease. Results-The high incidence of imported malaria (0.70%) and the low costs of providing chemoprophylaxis resulted in a cost-benefit ratio of 0.19 for chloroquine and proguanil and 0.57 for a regimen containing mefloquine. Hepatitis A infection occurred in 0.05% of visits and the cost of prophylaxis invariably exceeded the benefits for immunoglobulin (cost-benefit ratio 5.8) and inactivated hepatitis A vaccine (cost-benefit ratio 15.8). Similarly, low incidence of typhoid (0.02%) and its high cost gave whole cell killed, polysaccharide Vi, and oral Ty 21a typhoid vaccines cost-benefit ratios of 18.1, 18.0, and 22.0 respectively. Conclusions-Fewer than one third of travellers receive vaccines but the total cost of providing typhoid and hepatitis A prophylaxis of pound 25.8m is significantly higher than the treatment costs to the NHS (pound 1.03m) of cases avoided by prophylaxis. Neither hepatitis A prophylaxis nor typhoid prophylaxis is cost effective, but costs of treating malaria greatly exceed costs of chemoprophylaxis, which is therefore highly cost effective.