Effectiveness and Cost Comparison of Two Strategies for Hepatitis B Vaccination of Schoolchildren

By Guay, Maryse; Clouatre, Anne-Marie et al. | Canadian Journal of Public Health, January/February 2003 | Go to article overview

Effectiveness and Cost Comparison of Two Strategies for Hepatitis B Vaccination of Schoolchildren


Guay, Maryse, Clouatre, Anne-Marie, Blackburn, Manon, Baron, Genevieve, et al., Canadian Journal of Public Health


ABSTRACT

Context: In 1994, immunization against hepatitis B was implemented in schools in Quebec, targeting grade 4 students. In 1996-1997 and 1997-1998, one Local Community Service Centre (CLSC) replaced the school-based program in its district with vaccination offered in community clinics after school hours. The aim of the current study was to compare the effectiveness and costs of school-based and clinic-based programs.

Methods: Vaccination coverage data were collected in the CLSC with the clinic-based program (CBP), and in three matched CLSCs with a school-based program (SBP), from 1994 to 2000. Surveys were conducted to estimate costs to parents, to schools and to CLSCs in 1997-1998.

Results: With the implementation of the CBP, the vaccination coverage fell to 73%, compared with over 90% in the SBPs. Coverage increased to 90% when the CBP was abandoned. Costs to the CLSC were not much lower in the CBP. Societal costs were $63 per student vaccinated in the CBP, and <= $40 in the SBPs.

Conclusion: Results demonstrate the advantage of SBP over a CBP for the immunization of schoolchildren.

In 1994, a school-based hepatitis B vaccination program targeting grade 4 students was implemented in the Province of Quebec.1 School nurses from Local Community Service Centres (CLSC) provide vaccination during school hours in all schools in their territory. In 1996, for organizational reasons, the authorities of one CLSC in the Monteregie Health Region decided to offer vaccination at special vaccination clinics after school hours. When this decision was made, it was assumed that costs to the health system would be reduced, and that coverage of the target population would be minimally affected.

Many studies, mostly descriptive, have examined school-based hepatitis B vaccination for its feasibility or practical aspects,2-7 and some economic analyses looked at the costs of hepatitis B vaccination for different populations.8-14 Only two studies examined costs of school-based vaccination programs, and both were on hepatitis B vaccination.15,16 One study found the cost per dose of a school-based program to be significantly less than that of a HMObased program; however, vaccine coverage was not measured in this study.15 The second study found the costs of a schoolbased hepatitis B vaccination program to be lower than administration during regular health visits (estimated in another economic evaluation).11,16 Review of the scientific literature found little evidence of the effectiveness of school-based strategies for improving vaccine uptake other than laws or regulations requiring vaccination for school entry. 17-20

Starting from the quasi-experiment conducted by one CLSC in Monteregie, we performed a study aimed at comparing the effectiveness and costs of a community clinic-based program (CBP) versus a school-based program (SBP) for vaccinating school-aged children against hepatitis B.

METHODS

Study population

Monteregie is the second largest of the 18 health regions in the Province of Quebec. Public health services are provided by 19 CLSCs. From the beginning of the provincial immunization program against hepatitis B in 1994, Grade 4 students were eligible and immunization was offered at school during school hours. Parents were contacted via letters sent from school with information on the hepatitis B vaccination program and consent forms. Follow-up phone calls were done by school nurses for children not having the returned consent forms. No hepatitis B vaccine was provided by physicians in the region.

In 1996, one CLSC in the region, in agreement with the local school board, decided to offer vaccination by appointment at three different times for each dose: two on Saturdays between 9 am and 4 pm at one community site and one on Wednesday nights between 4 and 9 pm at another community site. Parents were contacted via letters from school. Children had to be accompanied by an adult at the time of vaccination. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Effectiveness and Cost Comparison of Two Strategies for Hepatitis B Vaccination of Schoolchildren
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Author Advanced search

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.