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Hepatitis A infection in aircrews: risk of infection and cost-benefit analysis of hepatitis A vaccination |
Gutersohn T, Steffen R, Van Damme P, Holdener F, Beutels P |
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Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Economic study type Cost-effectiveness analysis.
Setting European based carrier with flights to international destinations.
Dates to which data relate The data for the effectiveness and resource use analyses were collected between 1987-1991. The price date was not clearly reported.
Source of effectiveness data Link between effectiveness and cost data The costing was undertaken retrospectively on the same patient sample as that used in the effectiveness analysis.
Study sample Health records of 6,477 Swiss aircrew over 5 years were scrutinised to assess the number of personnel with symptomatic Hepatitis A. The denominator was 2,879 likely susceptible individuals in the Swissair aircrew population. The incidence rates were compared with those available from a similar airline - SABENA, the Belgian national carrier.
Study design Economic model based on retrospective cohort.
Analysis of effectiveness The reduction in cases of Hepatitis A (HA) with vaccination, assuming 100% coverage and efficacy, was the primary health outcome used in the analysis. The annual HA incidence rate was 12.2 cases per 1,000 individuals.
Effectiveness results The vaccination would result in 4.4 cases avoided per year per 3,322 flying personnel.
Measure of benefits used in the economic analysis The reduction in cases of Hepatitis A (HA) with vaccination, assuming 100% coverage and efficacy, was the measure of benefit used in the analysis.
Direct costs Costs were not reported as discounted. The quantities of resource use were reported separately from costs. These included operating costs, overheads, salaries lost due to sick leave, and capital ("infrastructural" vaccination) costs. The estimation of resource use was based on the authors' assumptions, with the boundaries being those of the airline medical service and the crew. The price date used in the analysis was not reported.
Estimated benefits used in the economic analysis The vaccination would result in 4.4 cases avoided per year per 3,322 flying personnel.
Cost results The overall vaccination programme cost per year was $332,200 for a given total crew of 3,322 individuals. The cost of Hepatitis A cases for the airline was $66,200 per year. The cost of Hepatitis A per pilot per year was $43, whereas the cost per flight attendant per year was $11. Given the $100 cost of the vaccination programme per individual (cycle, $50, plus administration, $50), it follows that HA vaccination for all Swissair aircrew members becomes cost-saving after 2.4 years, and after 10 and 9 years for pilots and cabin crew, respectively. As the average cabin crew member serves 13 years in the airline, it is in the airline's interests to vaccinate all aircrew against HA.
Synthesis of costs and benefits Authors' conclusions HA infection appears to be a professional risk of air crews working on flights to developing countries Since the average cabin crew member serves 13 years in the airline, it is in the airline's interests to vaccinate all aircrew against HA. Thus, vaccination is recommended and may be cost saving in the long run (with the exception of female cabin crew). Swissair currently funds the second vaccination whereas the first is charged to the employee.
CRD COMMENTARY - Selection of comparators The reason for the choice of comparator is clear: it was the 'do-nothing' option. Validity of estimate of measure of benefit The measure of clinical benefit was based upon an assumption of 100% vaccine coverage, which may be unreasonable. Validity of estimate of costs The quantities of resource use were reported separately from the costs. No adequate details of cost estimation were given. Thus, one cannot state whether or not important cost items were omitted from the analysis. The costs were not discounted, despite the fact that the time span considered was assumed as 10 years at the least. Other issues The authors' conclusions were not justified in terms of the uncertainties in the data. The study was not a cost-benefit analysis, since the benefits of the reduction in illness to the people were not included. The results are generalisable only to the extent that the incidence of Hepatitis A is similar in other crews. Implications of the study Given the flaws of the study (described in the commentary above), no practical implications can be defined. Bibliographic details Gutersohn T, Steffen R, Van Damme P, Holdener F, Beutels P. Hepatitis A infection in aircrews: risk of infection and cost-benefit analysis of hepatitis A vaccination. Aviation Space and Environmental Medicine 1996; 67(2): 153-156 Indexing Status Subject indexing assigned by NLM MeSH Adult; Aviation /statistics & Comparative Study; Cost-Benefit Analysis; Female; Hepatitis A /prevention & Humans; Incidence; Male; Middle Aged; Retrospective Studies; Switzerland /epidemiology; Vaccination /adverse effects /economics; Viral Hepatitis Vaccines /economics; control /economics /epidemiology; numerical data AccessionNumber 21996000267 Date bibliographic record published 31/05/1998 Date abstract record published 31/05/1998 |
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