Integration of hepatitis B vaccination into national immunisation programmes

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7130.552a (Published 14 February 1998) Cite this as: BMJ 1998;316:552

Authors should have taken open minded view of all relevant evidence

  1. W J Edmunds, Wellcome Fund postdoctoral research fellowa
  1. a Department of Biological Sciences, University of Warwick, Coventry CV4 7AL
  2. b World Health Organisation, Geneva, Switzerland
  3. c Centre for the Evaluation of Vaccination, Epidemiology and Community Medicine, University of Antwerp, Belgium

    Editor—There is currently considerable interest in strategies of vaccination against hepatitis B in areas of low endemicity, such as the United Kingdom. Since there is little argument over whether this vaccination is safe, effective, and desirable given sufficient resources, the debate has largely focused on the relative cost effectiveness of selective versus mass immunisation options.

    In their article Van Damme et al used economic (and other) arguments to advocate mass immunisation against hepatitis B.1 Unfortunately, their section on economic evaluation is misleading. Specifically, on page 1035 they state that “cost effectiveness studies performed in countries with low endemicity (Belgium, Canada, United Kingdom, United States) consistently find that universal vaccination is economically attractive.” They support this statement by referencing four studies. They do not, however, reference those studies that do not agree with this statement (such as that by Williams et al on the cost effectiveness of vaccination against hepatitis B in the United Kingdom2). The evidence is therefore not consistent. …

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