Cost-benefit analysis of a nationwide neonatal inoculation programme against hepatitis B in an area of intermediate endemicity.

STUDY OBJECTIVE: The aim was to estimate the costs and benefits of a nationwide neonatal vaccination campaign against hepatitis B in Israel for the 1990-2034 period. DESIGN: Using morbidity, mortality, utilisation, and cost data from Israeli and international sources, a spreadsheet model was constructed to carry out the cost-benefit analysis. SETTING: The entire State of Israel, an area of intermediate endemicity. PARTICIPANTS: The population of Israel from 1990-2034. MAIN RESULTS: A policy of immunising all Israeli neonates would, for a cost of 13. 8 million, reduce the number of cases of hepatitis B during the 1990-2035 period in the cohort from 359, 000 to 166, 000 and save the nation around 21. 5 million in health resources alone, 16. 6 million in averted work absences, and a further 0. 6 million in averted premature mortality costs. Even when the savings to the health services (0. 6 million) arising from the reduction in hepatocellular carcinoma are excluded, the direct benefit to cost ratio is 1. 51/1, still in excess of unity. CONCLUSIONS: The decision to adopt a nationwide neonatal inoculation policy, starting in January 1992, appears to be not only medically but also economically justifiable.