E-drug: Hepatitis B costs
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We would like to respond to Dr Thaver's enquiry about Hep B vaccine. We
carried out a cost benefit analysis of Hepatitis B immunisation in Romania
in 1996. (Gary M. Ginsberg and Rachel Feilden "Cost Benefit Analysis of
hepatitis B Immunisation for newborns in Romania." FBA and UNICEF September
1996). This study found that taking all long term, indirect and societal
benefits into account the benefit to cost ratio for Romania was 0.89:1
when using a European manufactured recombinant DNA vaccine. However using
a plasma derived vaccine would give a benefit to cost ratio of 1.25:1 WHO
has indicated that both plasma and recombinant hepatitis B vaccine provide
the necessary protection. See "Towards the Elimination of Hepatitis B:
International Conference on control of Hepatitis B in the developing
world." Yaounde, Cameroun October 1991.
Romania introduced Hep B vaccine in 1995 and during the run up SKB
sponsored a symposium in Bucharest. At that meeting SKB staff presented
papers suggesting that only recombinant DNA vaccine in general and SKB's
vaccine in particular would really provide full protection. Dr Mark Kane,
the focal point for Hep B in WHO Geneva, has made it clear that as far as
WHO is concerned either vaccine is equally effective. After our CBA was
carried out a new producer of recombinant DNA vaccine (LG of Korea) has
been approved by WHO. The cost of their vaccine is substantially lower than
that of European and North American manufacturers but higher than the Far
Eastern manufacturers of plasma derived vaccine.
For another piece of work which we carried out into the feasibility of
offering Hep B to older children ("A cost Recovery Mechanism to Make
Hepatitis B Vaccine Available for Out-of-Age Children" Rachel Feilden and
Anthony Battersby FBA and UNICEF March 1997) we were quoted a price (CIF)
of $1.14 per dose in a 10 dose presentation for LG's DNA vaccine. By
comparison SKB cost $2.37 for the same presentation and Cheil Jedang
(plasma) $0.65. UNICEF sells LG for $0.96. However the higher price
quoted directly by LG included the possibility of buying "on commission"
This mechanism enables the buyer to pay for the vaccine only when he takes
it from bond, in other words the manufacturer takes the financial risk of
bringing the vaccine into the country. For this reason the unit price is a
little higher than the UNICEF price.
Two points arise: Firstly the cost benefit analysis of Hep B immunisation
is very sensitive to the investment a country makes in its health service.
Thus in a country such as Belgium where over $500 per capita is spent on
health, Hep B immunisation is cost effective. In Romania spending $39 it
is not cost-effective using recombinant DNA, but is cost-effective using
plasma derived.
Secondly if you are considering introducing the vaccine, establish the
DDP (delivered, duty paid) cost of the vaccine from selected
manufacturers before making a decision.
Anthony Battersby and Rachel Feilden
FBA Health Systems Analysts
Email: FBA@compuserve.com
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