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Background. Routine childhood hepatitis A immunization is recommended in regions with incidence rates twice the national average, but it may be cost-effective in a wider geographic area.

Objective. To evaluate the costs and benefits of potential hepatitis A immunization of healthy US children in regions with varying hepatitis A incidences.

Methods. We considered vaccination of the 2000 US birth cohort in states defined by historic hepatitis A incidence rates. Infections among potential vaccinees and their personal contacts were predicted from age 2 through 85 years. Net vaccination costs were estimated from health system and societal perspectives and were compared with life-years saved and quality-adjusted life years (QALYs) gained using a 3% discount rate.

Results. Nationally vaccination would prevent >75 000 cases of overt hepatitis A disease. Approximately two-thirds of health benefits would accrue to personal contacts rather than to vaccinees themselves. In states with incidence rates of >=200%, 100 to 199%, 50 to 99% and <50% the national average, societal costs per QALY gained would be <$0, <$0, $13 800 and $63 000, respectively. Nationally vaccination would cost $9100 per QALY gained from the perspective of the health system and $1400 per QALY gained from society's perspective. Results are most sensitive to vaccination costs and rates of disease transmission through personal contact.

Conclusion. Childhood hepatitis A vaccination is most cost-effective in areas with the highest incidence rates but would also meet accepted standards of economic efficiency in most of the US. A national immunization policy would prevent substantial morbidity and mortality, with cost effectiveness similar to that of other childhood immunizations.

(C) 2003 Lippincott Williams & Wilkins, Inc.