Methods: A comprehensive literature search was conducted to identify data on cost of hepatitis A. Medline (Jan 1966-Mar 2005), Embase (Jan 1980-Mar 2005), HealthSTAR (Jan 1975-Mar 2005), and Social Sciences Citation Index (Jan 1945-Mar 2005). Exploded MeSH: ["cost" OR "cost-benefit" OR "cost-effectiveness" OR "decision analysis"] AND "hepatitis A". Similar literature search was conducted to identify resources utilization data for Canada. Unpublished sources were consulted, including the Ontario Case Costing Initiative, and public health websites (e.g., Statistics Canada and provincial Ministries of Health). Remaining data gaps were solicited from an expert consultation. Ministry perspective included direct infection costs (hospitalization, physician visits, etc.). Societal perspective included direct costs plus time costs (cost of lost productivity). All costs were expressed in 2005 Canadian dollars.

Results: It was estimated that approximately 67% of symptomatic HA cases were reported to public health. The average direct cost per symptomatic case was $1,449, and increased with age. Approximately half of the total direct cost was attributed to hospitalization (48%), followed by physician visits and testing (26%), public health costs (23%), and liver transplant and death (1% each). The average cost per symptomatic case was $2,889 when time costs were included. The highest cost was in adults aged Ан30 years ($4,300). In pre-vaccination era (1988-1994), the annual cost of reported cases was approximately $5.6 million from societal perspective ($3.4 million from a ministry perspective). The annual cost related to HA- reported cases for the period of 1995-2003 decreased to $4.1 million from a societal perspective ($2.3 million from a ministry perspective). The age group incurring the largest societal cost is 30-59, with approximately 62% of the total societal cost for 1995-2003 (50% for total ministry costs).

Conclusion: This study provides some insight into the direct and societal costs of Hepatitis A in Canada and places an upper bound on cost saving associated with universal vaccination. HA remains a significant public health and economic burden, despite the decrease in the reported incidence.