Cookies on this website

We use cookies to ensure that we give you the best experience on our website. If you click 'Accept all cookies' we'll assume that you are happy to receive all cookies and you won't see this message again. If you click 'Reject all non-essential cookies' only necessary cookies providing core functionality such as security, network management, and accessibility will be enabled. Click 'Find out more' for information on how to change your cookie settings.

We conducted a study to analyse the efficiency of introducing vaccination against hepatitis A to the schedule for troops in the British Army. The study design included a cost-effectiveness analysis (CEA) of cost per case avoided comparing active and passive immunization and a cost-benefit analysis (CBA). The study population comprised all British Army personnel as well as those soldiers assumed to be deployed to high-risk areas a variable number of times in 5 years. The average cost of one case of hepatitis A avoided by vaccination was calculated and compared with the average cost of achieving the same outcome by passive immunization. In a 5-year four-exposure scenario at a low incidence and using a 3% discount rate, avoiding one case of hepatitis A by vaccination would cost £52 865, against £97 305 by passive immunization. The equivalent cost-benefit ratios are 13.4 for gammaglobulin and 7.2 for vaccine. For fewer exposures the break-even point for vaccine is two exposures in 4 years. Although our estimates are sensitive to direct costs and relatively sensitive to the estimated incidence, vaccinating troops against hepatitis A appears to be a more efficient procedure than passive immunization, especially as a long-term investment in troops likely to effect several operational deployments. Given the difficulty of forecasting which troops would deploy, the best-buy strategy may be vaccination of troops most likely to deploy repeatedly. © 1994.

Original publication




Journal article



Publication Date





1379 - 1383