Cost-Effectiveness Analysis of Hepatitis A Vaccination in Contrasting Economic Environments

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Cost-Effectiveness Analysis of Hepatitis A Vaccination in Contrasting Economic Environments

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Hepatitis A is one of the most common vaccine-preventable diseases. The virus is one of the greatest causes of foodborne infection, with epidemics often rapidly spreading through food and water sources. In its most severe cases, the disease can result in the need for a liver transplant or death. Complications can include recurring symptoms over several months. Most commonly, the disease causes a great amount of lost productivity and medical costs (WHO, 2010). In today’s rapidly changing world, many economies are developing quickly and countries are experiencing higher levels of sanitation, resulting in an epidemiological shift of the hepatitis A virus in many locations. The epidemiological shift occurs when children avoid being infected with the disease until a later age due to cleaner water sources, food, and hygiene practices in their environment; but if and when they are infected at this later age, the disease is much more severe and lost productivity costs are higher (Lopez et al, 2007). A hepatitis A vaccine exists, yet remains underutilized throughout much of the world (WHO, 2010). The vast number of hepatitis A cases, as well as the looming potential severity of an increasing average age of infection in many regions, creates a need for an evaluation of current hepatitis A vaccination strategies to ensure that those that are being implemented are most beneficial to society. Hepatitis A vaccination recommendations are often outdated or nonexistent. Several developed nations have vaccination strategies that target high-risk groups or children who live in areas with high incidence rates of the disease (Armstrong et al, 2007), but often fail to routinely reevaluate vaccination strategies once universal vaccination policies have been put in place (Plotkin et al, 2013). This is despite the cyclical nature of hepatitis A, which generally has a large increase in incidence every ten years, followed by a decrease to a rate lower than the previous baseline incidence (Fiore, 2004). With very few exceptions, developing countries generally have no recommendations and sparse resources dedicated to research on the disease (Quezada et al, 2008). In order to determine the strategies that will currently be most beneficial in terms of quality-adjusted life years (QALYs) and cost, I have created a model and conducted a cost-effectiveness analysis to investigate vaccination recommendation strategies in a More Economically Developed Country (MEDC), commonly known as a “developed” area, the United States, and a Less Economically Developed Country (LEDC), commonly known as a “developing” area, or in this case, the state of Rio de Janeiro, Brazil. In 2009, and currently, these two areas had different vaccination strategies for hepatitis A. The model ran two different scenarios – in the USA, I modeled the universal vaccination policy and what it would look like if it was taken away, and in Rio de Janeiro, I modeled no vaccination, as well as what it would look like if a universal vaccination policy was implemented. I have also conducted an analysis to show, if this epidemiological shift of the disease continues in these regions, what type of future burden hepatitis A may have in a hypothetical rapidly-developing country.


University of Minnesota Ph.D. dissertation. December 2018. Major: Health Services Research, Policy and Administration. Advisors: Karen Kuntz, Eva Enns. 1 computer file (PDF); viii, 127 pages.

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Ghildayal, Nidhi. (2018). Cost-Effectiveness Analysis of Hepatitis A Vaccination in Contrasting Economic Environments. Retrieved from the University Digital Conservancy,

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