Search tips
Search criteria 


Logo of pubhealthrepPublic Health Reports
Public Health Rep. 2003 Nov-Dec; 118(6): 550–558.
PMCID: PMC1497596

An economic assessment of pre-vaccination screening for hepatitis A and B.


OBJECTIVE: The availability of a single vaccine active against hepatitis A and B may facilitate prevention of both infections, but complicates the question of whether to conduct pre-vaccination screening. The authors examined the cost-effectiveness of pre-vaccination screening for several populations: first-year college students, military recruits, travelers to hepatitis A-endemic areas, patients at sexually transmitted disease clinics, and prison inmates. METHODS: Three prevention protocols were examined: (1) screen and defer vaccination until serology results are known; (2) screen and begin vaccination immediately to avoid a missed vaccination opportunity; and (3) vaccinate without screening. Data describing pre-vaccination immunity, vaccine effectiveness, and prevention costs borne by the health system (i.e., serology, vaccine acquisition, and administration) were derived from published literature and U.S. government websites. Using spreadsheet models, the authors calculated the ratio of prevention costs to the number of vaccine protections conferred. RESULTS: The vaccinate without screening protocol was most cost-effective in nine of 10 analyses conducted under baseline assumptions, and in 69 of 80 sensitivity analyses. In each population considered, vaccinate without screening was less costly than and at least equally as effective as screen and begin vaccination. The screen and defer vaccination protocol would reduce costs in seven populations, but effectiveness would also be lower. CONCLUSIONS: Unless directed at vaccination candidates with the highest probability of immunity, pre-vaccination screening for hepatitis A and B immunity is not cost-effective. Balancing cost reduction with reduced effectiveness, screen and defer may be preferred for older travelers and prison inmates.

Full Text

The Full Text of this article is available as a PDF (89K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Coleman PJ, McQuillan GM, Moyer LA, Lambert SB, Margolis HS. Incidence of hepatitis B virus infection in the United States, 1976-1994: estimates from the National Health and Nutrition Examination Surveys. J Infect Dis. 1998 Oct;178(4):954–959. [PubMed]
  • Meyerhoff AS, Jacobs RJ. Transmission of hepatitis A through household contact. J Viral Hepat. 2001 Nov;8(6):454–458. [PubMed]
  • Blostein J, Clark PA. Cost-effectiveness of preimmunization hepatitis B screening in high-risk adolescents. Public Health Rep. 2001 Mar-Apr;116(2):165–168. [PMC free article] [PubMed]
  • Lee KK, Beyer-Blodget J. Screening travelers for hepatitis A antibodies: an observational cost-comparison study of vaccine use. West J Med. 2000 Nov;173(5):325–329. [PMC free article] [PubMed]
  • Licciardone JC. Screening international travelers for hepatitis A antibodies versus routine vaccination: how generalizable are the results? West J Med. 2000 Nov;173(5):329–330. [PMC free article] [PubMed]
  • Saab S, Martin P, Yee HF., Jr A simple cost-decision analysis model comparing two strategies for hepatitis A vaccination. Am J Med. 2000 Aug 15;109(3):241–244. [PubMed]
  • Yuan L, Robinson G. Hepatitis B vaccination and screening for markers at a sexually transmitted disease clinic for men. Can J Public Health. 1994 Sep-Oct;85(5):338–341. [PubMed]
  • Sellors J, Zimic-Vincetic M, Howard M, Mahony JB, Chernesky MA. Predictors of positivity for hepatitis B and the derivation of a selective screening rule in a Canadian sexually transmitted disease clinic. J Clin Virol. 1998 Jul 24;11(1):85–91. [PubMed]
  • van Duynhoven YT, van de Laar MJ, Schop WA, Rothbarth PH, van der Meijden WI, van Loon AM, Sprenger MJ. Prevalence and risk factors for hepatitis B virus infections among visitors to an STD clinic. Genitourin Med. 1997 Dec;73(6):488–492. [PMC free article] [PubMed]
  • Gunn RA, Murray PJ, Ackers ML, Hardison WG, Margolis HS. Screening for chronic hepatitis B and C virus infections in an urban sexually transmitted disease clinic: rationale for integrating services. Sex Transm Dis. 2001 Mar;28(3):166–170. [PubMed]
  • Anda RF, Perlman SB, D'Alessio DJ, Davis JP, Dodson VN. Hepatitis B in Wisconsin male prisoners: considerations for serologic screening and vaccination. Am J Public Health. 1985 Oct;75(10):1182–1185. [PubMed]
  • Decker MD, Vaughn WK, Brodie JS, Hutcheson RH, Jr, Schaffner W. Seroepidemiology of hepatitis B in Tennessee prisoners. J Infect Dis. 1984 Sep;150(3):450–459. [PubMed]
  • Hull HF, Lyons LH, Mann JM, Hadler SC, Steece R, Skeels MR. Incidence of hepatitis B in the penitentiary of New Mexico. Am J Public Health. 1985 Oct;75(10):1213–1214. [PubMed]
  • Beutels P. Economic evaluations of hepatitis B immunization: a global review of recent studies (1994-2000). Health Econ. 2001 Dec;10(8):751–774. [PubMed]
  • Rosenthal Philip. Cost-effectiveness of hepatitis A vaccination in children, adolescents, and adults. Hepatology. 2003 Jan;37(1):44–51. [PubMed]
  • Armstrong Gregory L, Bell Beth P. Hepatitis A virus infections in the United States: model-based estimates and implications for childhood immunization. Pediatrics. 2002 May;109(5):839–845. [PubMed]
  • Margolis HS, Coleman PJ, Brown RE, Mast EE, Sheingold SH, Arevalo JA. Prevention of hepatitis B virus transmission by immunization. An economic analysis of current recommendations. JAMA. 1995 Oct 18;274(15):1201–1208. [PubMed]
  • Das A. An economic analysis of different strategies of immunization against hepatitis A virus in developed countries. Hepatology. 1999 Feb;29(2):548–552. [PubMed]
  • Jacobs RJ, Margolis HS, Coleman PJ. The cost-effectiveness of adolescent hepatitis A vaccination in states with the highest disease rates. Arch Pediatr Adolesc Med. 2000 Aug;154(8):763–770. [PubMed]
  • Smith S, Weber S, Wiblin T, Nettleman M. Cost-effectiveness of hepatitis A vaccination in healthcare workers. Infect Control Hosp Epidemiol. 1997 Oct;18(10):688–691. [PubMed]
  • O'Connor JB, Imperiale TF, Singer ME. Cost-effectiveness analysis of hepatitis A vaccination strategies for adults. Hepatology. 1999 Oct;30(4):1077–1081. [PubMed]
  • Pisu Maria, Meltzer Martin Isaac, Lyerla Rob. Cost-effectiveness of hepatitis B vaccination of prison inmates. Vaccine. 2002 Dec 13;21(3-4):312–321. [PubMed]
  • Van Doorslaer E, Tormans G, Van Damme P. Cost-effectiveness analysis of vaccination against hepatitis A in travellers. J Med Virol. 1994 Dec;44(4):463–469. [PubMed]
  • Arguedas Miguel R, Heudebert Gustavo R, Fallon Michael B, Stinnett Aaron A. The cost-effectiveness of hepatitis A vaccination in patients with chronic hepatitis C viral infection in the United States. Am J Gastroenterol. 2002 Mar;97(3):721–728. [PubMed]
  • Ruiz JD, Molitor F, Sun RK, Mikanda J, Facer M, Colford JM, Jr, Rutherford GW, Ascher MS. Prevalence and correlates of hepatitis C virus infection among inmates entering the California correctional system. West J Med. 1999 Mar;170(3):156–160. [PMC free article] [PubMed]
  • Skidmore S, Parry JV, Nottage P. An investigation of the potential risk of an HAV outbreak in a prison population following the introduction of cases from a community outbreak. Commun Dis Public Health. 2001 Jun;4(2):133–135. [PubMed]
  • Whiteman D, McCall B, Falconer A. Prevalence and determinants of hepatitis A virus exposure among prison entrants in Queensland, Australia: implications for public health control. J Viral Hepat. 1998 Jul;5(4):277–283. [PubMed]
  • Bloom BS, Hillman AL, Fendrick AM, Schwartz JS. A reappraisal of hepatitis B virus vaccination strategies using cost-effectiveness analysis. Ann Intern Med. 1993 Feb 15;118(4):298–306. [PubMed]
  • Myers RP, Gregor JC, Marotta PJ. The cost-effectiveness of hepatitis A vaccination in patients with chronic hepatitis C. Hepatology. 2000 Apr;31(4):834–839. [PubMed]
  • Jacobs R Jake, Koff Raymond S, Meyerhoff Allen S. The cost-effectiveness of vaccinating chronic hepatitis C patients against hepatitis A. Am J Gastroenterol. 2002 Feb;97(2):427–434. [PubMed]
  • Thoelen S, Van Damme P, Leentvaar-Kuypers A, Leroux-Roels G, Bruguera M, Frei PC, Bakasenas V, Safary A. The first combined vaccine against hepatitis A and B: an overview. Vaccine. 1999 Mar 26;17(13-14):1657–1662. [PubMed]
  • Rendi-Wagner P, Kundi M, Stemberger H, Wiedermann G, Holzmann H, Hofer M, Wiesinger K, Kollaritsch H. Antibody-response to three recombinant hepatitis B vaccines: comparative evaluation of multicenter travel-clinic based experience. Vaccine. 2001 Feb 28;19(15-16):2055–2060. [PubMed]
  • Steffen R. Immunization against hepatitis A and hepatitis B infections. J Travel Med. 2001 Jan;8 (Suppl 1):S9–16. [PubMed]
  • Krahn M, Guasparini R, Sherman M, Detsky AS. Costs and cost-effectiveness of a universal, school-based hepatitis B vaccination program. Am J Public Health. 1998 Nov;88(11):1638–1644. [PubMed]

Articles from Public Health Reports are provided here courtesy of SAGE Publications