Is travel prophylaxis worth while? Economic appraisal of prophylactic measures against malaria, hepatitis A, and typhoid in travellers
BMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6959.918 (Published 08 October 1994) Cite this as: BMJ 1994;309:918
- R H Behrens,
- J A Roberts
- Hospital for Tropical Diseases Travel Clinic, London NW1 0PE
- Health Services Research Unit, London School of Hygiene and Tropical Medicine, London WC1T 7HT20
- Correspondence to: Dr Behrens.
- Accepted 18 July 1994
Abstract
Objectives: To estimate the costs and benefits of prophylaxis against travel acquired malaria, typhoid20fever, and hepatitis A in United Kingdom residents during 1991.
Design: Retrospective analysis of national epidemiological and economic data.
Main outcome measures: Incidence of travel associated infections in susceptible United Kingdom residents per visit; costs of prophylaxis provision from historical data; benefits to the health sector, community, and individuals in terms of avoided morbidity and mortality based on hospital and community costs of disease.
Results: The high incidence of imported malaria (0.70%) and the low costs of providing chemoprophylaxis resulted in a cost-benefit ratio of 0.19 for chloroquine and proguanil and 0.57 for a regimen containing mefloquine. Hepatitis A infection occurred in 0.05% of visits and the cost of prophylaxis invariably exceeded the benefits for immunoglobulin (cost-benefit ratio 5.8) and inactivated hepatitis A vaccine (cost- benefit ratio 15.8). Similarly, low incidence of typhoid (0.02%) and its high cost gave whole cell killed, polysaccharide Vi, and oral Ty 21a typhoid vaccines cost-benefit ratios of 18.1, 18.0, and 22.0 respectively.
Conclusions: Fewer than one third of travellers receive vaccines but the total cost of providing typhoid and hepatitis A prophylaxis of pounds sterling25.8m is significantly higher than the treatment costs to the NHS (pounds sterling 1.03m) of cases avoided by prophylaxis. Neither hepatitis A prophylaxis nor typhoid prophylaxis is cost effective, but costs of treating malaria20greatly exceed costs of chemoprophylaxis, which is therefore highly cost effective.
Footnotes
- Accepted 18 July 1994