Prediction of Response to Hepatitis B Vaccine in Health Care Workers: Whose Titers of Antibody to Hepatitis B Surface Antigen Should Be Determined After a Three‐Dose Series, and What Are the Implications in Terms of Cost‐Effectiveness?

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Abstract
We identified the demographics of 385 health care workers (HCWs) to identify those whose chance of developing a protective response to a standard primary hepatitis B immunization series was so high that the need for testing for antibodies to hepatitis B surface antigen (anti-HBs) would be obviated following immunization. In addition, using sensitivity analysis, we analyzed the economic consequences of not determining anti-HBs titers for any individual after primary immunization and of using the Centers for Disease Control and Prevention (CDC)-recommended post-hepatitis B exposure prophylaxis for high-risk HCWs. Nonsmoking women .50 years old with a weight-height index of <42 had a 98.2 ± 0.9% chance of developing a protective anti-HBs titer. Male nonsmokers .50 years old with a weight-height index of <29 had a 94.7 ± 1.8% chance of a protective response. Economic analysis revealed that use of the CDC guidelines for post-hepatitis B exposure prophylaxis in male HCWs whose anti-HBs status is unknown is always more cost-effective than determining anti-HBs titers following primary immunization for those at high risk. In female HCWs, post- hepatitis B exposure prophylaxis is more cost-effective until hepatitis B exposure rates are ∼50%. It is possible to predict who will have a high probability of developing a protective response to hepatitis B vaccine; for these people, determining postimmunization anti-HBs titers is unnecessary and not cost-effective.

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