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Cost effectiveness of pneumococcal vaccination among Dutch infants: economic analysis of the seven valent pneumococcal conjugated vaccine and forecast for the 10 valent and 13 valent vaccines.
BMJ. 2010 Jun 02; 340:c2509.BMJ

Abstract

OBJECTIVES

To update cost effectiveness estimates for the four dose (3+1) schedule of the seven valent pneumococcal conjugated vaccine (PCV-7) in the Netherlands and to explore the impact on cost effectiveness of reduced dose schedules and implementation of 10 valent and 13 valent pneumococcal vaccines (PCV-10 and PCV-13).

DESIGN

Economic evaluation comparing PCV-7, PCV-10, and PCV-13 with no vaccination using a decision tree analytic model built from data in previous studies.

SETTING

The Netherlands. Population A cohort of 180,000 newborns followed until 5 years of age.

MAIN OUTCOME MEASURES

Costs; gains in life years and quality adjusted life years (QALYs); and incremental cost effectiveness ratios.

RESULTS

Under base case assumptions-that is, assuming a five year protective period of the vaccine and no assumed net indirect effects (herd protection minus serotype replacement) among children aged over 5 years-vaccination with PVC-7 in a four dose (3+1) schedule was estimated to prevent 71 and 5778 cases of invasive and non-invasive pneumococcal disease, respectively, in children aged up to 5 years. This corresponds with a total net gain of 173 life years or 277 QALYs. The incremental cost effectiveness ratio of PCV-7 was estimated at euro113,891 (pound98,300; $145,000) per QALY, well over the ratio of euro50,000 per QALY required for PCV-7 to be regarded as potentially cost effective. A three dose (2+1) schedule of PCV-7 reduced the incremental cost effectiveness ratio to euro82,975 per QALY. For various assumptions and including 10% of the maximum net indirect effects among individuals aged 5 years and over, PCV-10 and PCV-13 had incremental cost effectiveness ratios ranging from euro31,250 to euro52,947 per QALY.

CONCLUSIONS

The current Dutch infant vaccination programme of four doses of PCV-7 is not cost effective because of increases in invasive disease caused by non-vaccine serotypes, which reduces the overall direct effects of vaccination and offsets potential positive herd protection benefits in unvaccinated individuals. The 10 valent and 13 valent pneumococcal vaccines could have better net health benefits than PCV-7 through less replacement disease and increased herd protection. Both these effects could substantially reduce the incremental cost effectiveness ratio to possibly acceptable levels, if total programme costs can be lowered by reduced schedules, reductions in vaccine prices, or both.

Authors+Show Affiliations

Unit of PharmacoEpidemiology and PharmacoEconomics, Department of Pharmacy, University of Groningen, Groningen, Netherlands. m.h.rozenbaum@rug.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20519267

Citation

Rozenbaum, Mark H., et al. "Cost Effectiveness of Pneumococcal Vaccination Among Dutch Infants: Economic Analysis of the Seven Valent Pneumococcal Conjugated Vaccine and Forecast for the 10 Valent and 13 Valent Vaccines." BMJ (Clinical Research Ed.), vol. 340, 2010, p. c2509.
Rozenbaum MH, Sanders EA, van Hoek AJ, et al. Cost effectiveness of pneumococcal vaccination among Dutch infants: economic analysis of the seven valent pneumococcal conjugated vaccine and forecast for the 10 valent and 13 valent vaccines. BMJ. 2010;340:c2509.
Rozenbaum, M. H., Sanders, E. A., van Hoek, A. J., Jansen, A. G., van der Ende, A., van den Dobbelsteen, G., Rodenburg, G. D., Hak, E., & Postma, M. J. (2010). Cost effectiveness of pneumococcal vaccination among Dutch infants: economic analysis of the seven valent pneumococcal conjugated vaccine and forecast for the 10 valent and 13 valent vaccines. BMJ (Clinical Research Ed.), 340, c2509. https://doi.org/10.1136/bmj.c2509
Rozenbaum MH, et al. Cost Effectiveness of Pneumococcal Vaccination Among Dutch Infants: Economic Analysis of the Seven Valent Pneumococcal Conjugated Vaccine and Forecast for the 10 Valent and 13 Valent Vaccines. BMJ. 2010 Jun 2;340:c2509. PubMed PMID: 20519267.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost effectiveness of pneumococcal vaccination among Dutch infants: economic analysis of the seven valent pneumococcal conjugated vaccine and forecast for the 10 valent and 13 valent vaccines. AU - Rozenbaum,Mark H, AU - Sanders,Elisabeth A M, AU - van Hoek,Albert Jan, AU - Jansen,Angelique G S C, AU - van der Ende,Arie, AU - van den Dobbelsteen,Germie, AU - Rodenburg,Gerwin D, AU - Hak,Eelko, AU - Postma,Maarten J, Y1 - 2010/06/02/ PY - 2010/6/4/entrez PY - 2010/6/4/pubmed PY - 2010/6/18/medline SP - c2509 EP - c2509 JF - BMJ (Clinical research ed.) JO - BMJ VL - 340 N2 - OBJECTIVES: To update cost effectiveness estimates for the four dose (3+1) schedule of the seven valent pneumococcal conjugated vaccine (PCV-7) in the Netherlands and to explore the impact on cost effectiveness of reduced dose schedules and implementation of 10 valent and 13 valent pneumococcal vaccines (PCV-10 and PCV-13). DESIGN: Economic evaluation comparing PCV-7, PCV-10, and PCV-13 with no vaccination using a decision tree analytic model built from data in previous studies. SETTING: The Netherlands. Population A cohort of 180,000 newborns followed until 5 years of age. MAIN OUTCOME MEASURES: Costs; gains in life years and quality adjusted life years (QALYs); and incremental cost effectiveness ratios. RESULTS: Under base case assumptions-that is, assuming a five year protective period of the vaccine and no assumed net indirect effects (herd protection minus serotype replacement) among children aged over 5 years-vaccination with PVC-7 in a four dose (3+1) schedule was estimated to prevent 71 and 5778 cases of invasive and non-invasive pneumococcal disease, respectively, in children aged up to 5 years. This corresponds with a total net gain of 173 life years or 277 QALYs. The incremental cost effectiveness ratio of PCV-7 was estimated at euro113,891 (pound98,300; $145,000) per QALY, well over the ratio of euro50,000 per QALY required for PCV-7 to be regarded as potentially cost effective. A three dose (2+1) schedule of PCV-7 reduced the incremental cost effectiveness ratio to euro82,975 per QALY. For various assumptions and including 10% of the maximum net indirect effects among individuals aged 5 years and over, PCV-10 and PCV-13 had incremental cost effectiveness ratios ranging from euro31,250 to euro52,947 per QALY. CONCLUSIONS: The current Dutch infant vaccination programme of four doses of PCV-7 is not cost effective because of increases in invasive disease caused by non-vaccine serotypes, which reduces the overall direct effects of vaccination and offsets potential positive herd protection benefits in unvaccinated individuals. The 10 valent and 13 valent pneumococcal vaccines could have better net health benefits than PCV-7 through less replacement disease and increased herd protection. Both these effects could substantially reduce the incremental cost effectiveness ratio to possibly acceptable levels, if total programme costs can be lowered by reduced schedules, reductions in vaccine prices, or both. SN - 1756-1833 UR - https://www.unboundmedicine.com/medline/citation/20519267/Cost_effectiveness_of_pneumococcal_vaccination_among_Dutch_infants:_economic_analysis_of_the_seven_valent_pneumococcal_conjugated_vaccine_and_forecast_for_the_10_valent_and_13_valent_vaccines_ L2 - https://www.bmj.com/lookup/pmidlookup?view=long&pmid=20519267 DB - PRIME DP - Unbound Medicine ER -