Zhang, X-S;
Ong, JJ;
Macgregor, L;
Vilaplana, TG;
Heathcock, ST;
Mindlin, M;
Weatherburn, P;
Hickson, F;
Edelstein, M;
Mandal, S;
et al.
Zhang, X-S; Ong, JJ; Macgregor, L; Vilaplana, TG; Heathcock, ST; Mindlin, M; Weatherburn, P; Hickson, F; Edelstein, M; Mandal, S; Vickerman, P
(2022)
Transmission dynamics of the 2016-18 outbreak of hepatitis A among men who have sex with men in England and cost-effectiveness analysis of vaccination strategies to prevent future outbreaks.
Lancet Reg Health Eur, 19.
p. 100426.
ISSN 2666-7762
https://doi.org/10.1016/j.lanepe.2022.100426
SGUL Authors: Mindlin, Miranda Juliet
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Abstract
Background: Despite being vaccine-preventable, hepatitis A virus (HAV) outbreaks occur among men who have sex with men (MSM). We modelled the cost-effectiveness of vaccination strategies to prevent future outbreaks. Methods: A HAV transmission model was calibrated to HAV outbreak data for MSM in England over 2016-2018, producing estimates for the basic reproduction number (R0) and immunity levels (seroprevalence) post-outbreak. For a hypothetical outbreak in 2023 (same R0 and evolving immunity), the cost-effectiveness of pre-emptive (vaccination between outbreaks among MSM attending sexual health services (SHS)) and reactive (vaccination during outbreak among MSM attending SHS and primary care) vaccination strategies were modelled. Effectiveness in quality-adjusted life-years (QALYs) and costs were estimated (2017 UK pounds) from a societal perspective (10-year time horizon; 3% discount rate). The incremental cost-effectiveness ratio (ICER) was estimated. Findings: R0 for the 2016-2018 outbreak was 3·19 (95% credibility interval (95%CrI) 2·87-3·46); seroprevalence among MSM increased to 70·4% (95%CrI 67·3-72·8%) post-outbreak. For our hypothetical HAV outbreak in 2023, pre-emptively vaccinating MSM over the preceding five-years was cost-saving (compared to no vaccination) if the yearly vaccine coverage rate among MSM attending SHS was <9·1%. Reactive vaccination was also cost-saving compared to no vaccination, but was dominated by pre-emptive vaccination if the yearly vaccination rate was >8%. If the pre-emptive yearly vaccination rate fell below this threshold, it became cost-saving to add reactive vaccination to pre-emptive vaccination. Interpretation: Although highly transmissible, existing immunity limited the recent HAV outbreak among MSM in England. Pre-emptive vaccination between outbreaks, with reactive vaccination if indicated, is the best strategy for limiting future HAV outbreaks. Funding: NIHR.
Item Type: | Article | |||||||||
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Additional Information: | Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/) | |||||||||
Keywords: | Cost-effectiveness, Hepatitis A virus, Immunisation, Men who have sex with men | |||||||||
SGUL Research Institute / Research Centre: | Academic Structure > Population Health Research Institute (INPH) | |||||||||
Journal or Publication Title: | Lancet Reg Health Eur | |||||||||
ISSN: | 2666-7762 | |||||||||
Language: | eng | |||||||||
Dates: |
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Publisher License: | Creative Commons: Attribution 4.0 | |||||||||
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PubMed ID: | 36039276 | |||||||||
Go to PubMed abstract | ||||||||||
URI: | https://openaccess.sgul.ac.uk/id/eprint/114846 | |||||||||
Publisher's version: | https://doi.org/10.1016/j.lanepe.2022.100426 |
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