Kaafee Billah
1, Joanna Buffington
1,
Cindy Weinbaum1, Julie Subiadur
2, Richard Zimmerman
3, Paula Murray
4, and Robert Gunn
4. (1) Division of Viral Hepatitis/NCID, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, MS G-37, Atlanta, GA, USA, (2) Denver Public Health, Denver, CO, (3) STD Program, Illinois Department of Public Health, Springfield, IL, (4) Public Health Services, Health and Human Service Agency, San Diego County, San Diego, CA
BACKGROUND:
Prevaccination screening may save hepatitis B vaccination costs for some at-risk adult populations.
OBJECTIVE:
To assess the cost-effectiveness of prevaccination testing for antibody to hepatitis B core (anti-HBc), a marker of prior HBV infection, among STD clinic clients overall and by risk factors.
METHOD:
Prevalence of anti-HBc at which prevaccination testing becomes cost-saving was estimated using data from STD clinic vaccination projects in San Diego, Denver, and Illinois. A model was constructed using the algorithm of drawing blood for testing at the time of the first vaccine dose, and incorporating expected completion rates for second and third vaccine doses. Prevalence of anti-HBc by risk-factor groups in these projects and other studies were compared with model estimates of breakeven prevalence.
RESULT:
At $11 per anti-HBc test, $31 per vaccination dose, 53% completion for second dose and 30% for third dose among persons accepting the first dose, breakeven prevalence of anti-HBc was 43%. When testing cost is higher or completion rates are lower, breakeven prevalence is higher, making prevaccination testing even less cost-effective. Estimates of overall anti-HBc prevalence in STD clinics (12% to 28%) were far below estimated breakeven prevalence. However, estimates of prevalence of anti-HBc among men who have sex with men (MSM) (11% to 50%) and injection drug users (IDUs) (15% to 64%) show large variation and can be above or below the breakeven prevalence.
CONCLUSION:
Based on expected vaccine series completion rates, anti-HBc testing of all vaccine candidates at STD clinics would not be cost-effective. However, targeted testing of IDUs and MSM may be cost-effective in some settings.
LEARNING OBJECTIVES:
By the end of the session, participants will understand costs and cost-effectiveness of serologic testing before hepatitis B vaccination at STD clinics.