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Presentation

Session: Vaccination
Room: Meeting Rooms 25+26
Time: Fri 08:30-09:45

Presenter: Mark Rozenbaum (University of Groningen. Department of Pharmacy)

Abstract

OBJECTIVES: The objectives of the current analysis are: 1) to update cost-effectiveness
estimates for the current 4 dose schedule of 7-valent pneumococcal conjugate
vaccine (PCV7) using recent 2008 epidemiological data and new data obtained from
recent resource use for pneumococcal disease; 2) to investigate the cost-effectiveness
of a reduced-dose schedule, and switching to 10- or 13-valent pneumococcal vaccines.
METHODS: We constructed a decision analysis model to compare the expected net
costs and health benefits in two hypothetical cohorts of 180,000 children—one vaccinated
(with the PCV7/PCV10/PCV13) and one unvaccinated. Both herd protection
and serotype replacement were included for the cohorts, no net-vaccine benefits for
adults and elderly were included. RESULTS: Under base-case assumptions vaccination
with 4-doses of PCV7 prevents 72 cases of invasive pneumococcal disease and 6,801
cases of respiratory infections corresponding to a gain of 173 discounted life-years
or a gain of 270 QALYs. The cost savings due to vaccination is estimated at €2.7 million annually. With a vaccine price of €50, the cost-effectiveness ratio is estimated €116,847/QALY or €182,002/LYG. Using a 3-dose schedule lowers the CER to €85,104/QALY gained. At a threshold of €20,000/QALY switching from the 4-dose
PCV7 schedule to PCV10 or PCV13 could be cost-effective with an aggregated vaccination
cost below €219.76 or €240.64 for the PCV10 and PCV13, respectively. Costs
savings is reached below €205.28 or €210.88. CONCLUSIONS: Current routine
vaccination with four doses of PCV7 exhibits relatively high cost-effectiveness ratios
due to present rapid increase of non-vaccine serotype disease in vaccinated children
and absence of herd effects in unvaccinated individuals. Cost-effectiveness can be
improved using reduced dose schedules. In the presence of pneumococcal vaccination,
switching to the PCV10 or PCV13 seems health economically justified at limited price
increases.

Key Terms

pneumococcal vaccination, neumococcal conjugate vaccine, herd immunity, serotype replacement

Authors:

Mark Rozenbaum (University of Groningen. Department of Pharmacy) , Elisabeth Sanders (University Medical Center Utrecht. bWilhelmina Children Hospital) , Albert Jan van Hoek (University of Groningen. Department of Pharmacy) , Angelique Jansen (University Medical Center Utrecht. bWilhelmina Children Hospital) , Arie van der Ended (Academic Medical Center Amsterdam. Department of Medical Microbiology and the Netherlands Reference Laboratory for Bacterial Meningitis) and Germie van den Dobbelsteene (Netherlands Vaccine Institute)

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