Markov Decision Process for Comparative Economic Analysis of Immunization Strategies Against Hepatitis A Virus


Operations and Supply Chain Management

Date of this version


Document Type



Decision Making, Markov Process, Comparative Effectiveness Analysis, Cost Utility Analysis, Hepatitis A Vaccination Strategies


Hepatitis A vaccination in the U.S. is currently universally recommended for all children between the ages of one and two years. Several nations have vaccination strategies which target high-risk groups or children who live in areas with high incidence rates of the disease, but developing countries often have no recommendations due to their poor economic conditions and the effect this may have on access to vaccinations. This study uses Markov decision process for baseline cost utility and comparative effectiveness analyses of various vaccination strategies to counter hepatitis A virus between a developed country (U.S.) and a developing country (Mexico). Treeage Pro Healthcare software was employed in Markov decision analysis. Secondary data was utilized in the model from available literature. Results showed that for the U.S., the universal vaccination strategy was the most cost effective while the no vaccination strategy was the lowest cost. Whereas, for Mexico the effectiveness for both no vaccination and universal strategies were almost the same, however, the cost of no vaccination was the lowest. The results could alter hepatitis A vaccination guidelines and decrease the large amount of indirect and directs costs of the disease, while also potentially eradicating the severe cases or deaths that occur as a result of infection.

Published in

IEEE Transactions on Engineering Management

Citation/Other Information

44(1), 33-46