FIGURE 4-1 Estimated cost of adult hepatitis B vaccination per quality adjusted life year (QALY) gained for different age groups and different rates of acute hepatitis B virus (HBV) infection incidence. Incidence is expressed as the annual percentage of the population becoming acutely infected with HBV (for example, incidence of 0.005% means that 5 persons per 100,000 are acutely infected with HBV each year, and incidence of 0.075% means that 75 persons per 100,000 are acutely infected with HBV each year). Shadings show different levels of cost per QALY gained. Interventions are more cost-effective as one moves down (lower age) and to the right (higher incidence). Interventions that cost less than approximately $100,000 per QALY gained are generally considered cost-effective in the United States (Owens, 1998; WHO, 2009). The leftmost line, incidence of 0.0050%, is based on a recent estimate of acute hepatitis B incidence in the general US population (Hutton et al., 2007). Analysis performed by D. Hutton using the model developed in Hutton et al., 2007.

FIGURE 4-1 Estimated cost of adult hepatitis B vaccination per quality adjusted life year (QALY) gained for different age groups and different rates of acute hepatitis B virus (HBV) infection incidence. Incidence is expressed as the annual percentage of the population becoming acutely infected with HBV (for example, incidence of 0.005% means that 5 persons per 100,000 are acutely infected with HBV each year, and incidence of 0.075% means that 75 persons per 100,000 are acutely infected with HBV each year). Shadings show different levels of cost per QALY gained. Interventions are more cost-effective as one moves down (lower age) and to the right (higher incidence). Interventions that cost less than approximately $100,000 per QALY gained are generally considered cost-effective in the United States (Owens, 1998; WHO, 2009). The leftmost line, incidence of 0.0050%, is based on a recent estimate of acute hepatitis B incidence in the general US population (Hutton et al., 2007). Analysis performed by D. Hutton using the model developed in Hutton et al., 2007.

Adults at Risk from Sexual Exposure In a national sample of 500 sexually-transmitted-disease (STD) clinics, the percentage that offered the hepatitis B vaccine increased from 25% to 45% (p = 0.02) from 1997 to 2001, and the percentage of the clinics that considered all patients eligible for the vaccine rose from 9% to 26% (p = 0.023) during the same period (Gilbert et al., 2005). However, declining hepatitis B vaccination rates were reported in a study of six STD clinics in the United States (Harris et al., 2007). The researchers collected data on patient visits and hepatitis B vaccinations for



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