International Journal of Technology Assessment in Health Care

General Essays

An Economic Evaluation of the Introduction of Vaccination Against Hepatitis a in a Peacekeeping Operation: The Case of the United Nations Protection Force in Yugoslavia

Tom Jeffersona1, Vittorio Demichelia2 and David Wrighta3

a1 Medical Directorate, British Army of the Rhine

a2 University of Pavia

a3 Royal Army Medical College, London


The costs and benefits of vaccinating troops on United Nations tours in Yugoslavia against hepatitis A were compared. The marginal cost of one case of hepatitis A avoided by vaccination was calculated and compared with the marginal cost of achieving the same outcome by passive immunization. The cost-benefit ratio (medium estimate) for troops at low risk of contracting hepatitis A was 0.01 and for those at high risk was 0.03.

Vaccinating troops against hepatitis A for a single deployment appears to be an inefficient procedure, especially in troops at low risk. However, in professional troops from countries of low hepatitis A endemicity who are likely to be involved in several operational deployments, vaccination becomes more efficient the more times the same troops are deployed.