Elektronisk udgave - Sundhedsstyrelsen

The analysis of the health economics shows that based on an estimate for the
annual number of infections considered to be realistic, there will be substantial
net costs associated with the vaccination of infants. These costs are lower in
the case of immunization of 12-year-olds but they are still relatively high when
considered in relation to the health benefits of vaccination against hepatitis B.
Due to the specific circumstances of the price structure for the relevant vaccines
it is possible to introduce infant immunization using the hexavalent vaccine at
a cost no greater than that of the current immunization programme, but this
can hardly be considered as a health economic consequence of vaccination per
se. Vaccinations against hepatitis B in connection with the children’s immunization
programme can therefore not be directly recommended from a financial
standpoint.
Overall conclusion and recommendation
Hepatitis B is a serious infectious disease. It is a serious global public health
problem, and is the cause of a significant level of disease and death in third
world countries. Chronic infection only manifests itself in a small percentage
of infected adults. Rare, but serious consequences of chronic infection develop
after 20-40 years in the form of cirrhosis of the liver, liver cancer and liver
failure. In common with the rest of Scandinavia, Denmark has one of the
lowest incidences of hepatitis B, both in terms of the numbers of new cases of
hepatitis B, and the total number of chronic infections. The incidence of hepatitis
B has been consistently low over the last 10 years. At present, there are
no indications that the total incidence of the disease or the number of deaths
as a result of hepatitis B will change in the foreseeable future. Safe and effective
vaccines against hepatitis B are available. Vaccines can either be given as a
supplement to the existing children’s immunization programme, or through
the use of the new combined vaccines that also include protection against
hepatitis B. In general terms, the population is well informed about hepatitis
B. The attitude towards hepatitis B immunization is mostly positive. A sizeable
group of parents wishes to decide whether to opt for, or opt-out of hepatitis
B immunization for their children. The analysis of the financial implications
shows that the addition of separate hepatitis B vaccinations in conjunction
with the current children’s immunization programme will lead to a greater cost
burden for society. No additional direct costs would be incurred through the
use of the new hexavalent combined vaccines.
The advantages of introducing hepatitis B vaccinations as one element of the
children’s immunization programme will be that the number of cases of acute
hepatitis B will probable fall from the present level of 120 cases annually to
almost zero, and approx. 20 new reported cases of chronic hepatitis B will be
avoided. However, the effect will only manifest itself in approx. 15-20 years.
After many years (minimum 40-50), immunization will lead to a smaller number
of deaths (less than 10 per year) as a result of chronic liver disease. In the
short term there will be other related benefits. In particular, children will not
26 Indførelse af hepatitis B vaccination som en del af børnevaccinationsprogrammet i Danmark. En medicinsk teknologivurdering