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Cost-effectiveness of pneumococcal conjugate vaccination in Croatia.
Vaccine. 2015 May 07; 33 Suppl 1:A209-18.V

Abstract

OBJECTIVE

Pneumococcus is a known cause of meningitis, pneumonia, sepsis, and acute otitis media in children and adults globally. Two new vaccines for children have the potential to prevent illness, disability, and death, but these vaccines are expensive. The Croatian Ministry of Health has considered introducing the vaccine in the past, but requires economic evidence to ensure that the limited funds available for health care will be used in the most effective way.

METHODOLOGY

Croatia appointed a multidisciplinary team of experts to evaluate the cost-effectiveness of introducing pneumococcal conjugate vaccination (PCV) into the national routine child immunization program. Both 10-valent and 13-valent PCV (PCV10 and PCV13) were compared to a scenario assuming no vaccination. The TRIVAC decision-support model was used to estimate cost-effectiveness over the period 2014-2033. We used national evidence on demographics, pneumococcal disease incidence and mortality, the age distribution of disease in children, health service utilization, vaccine coverage, vaccine timeliness, and serotype coverage. Vaccine effectiveness was based on evidence from the scientific literature. Detailed health care costs were not available from the Croatian Institute for Health Insurance at the time of the analysis so assumptions and World Health Organization (WHO) estimates for Croatia were used. We assumed a three-dose primary vaccination schedule, and an initial price of US$ 30 per dose for PCV10 and US$ 35 per dose for PCV13. We ran univariate sensitivity analyses and multivariate scenario analyses.

RESULTS

Either vaccine is estimated to prevent approximately 100 hospital admissions and one death each year in children younger than five in Croatia. Compared to no vaccine, the discounted cost-effectiveness of either vaccine is estimated to be around US$ 69,000-77,000 per disability-adjusted life-years (DALYs) averted over the period 2014-2033 (from the government or societal perspective). Only two alternative scenarios were borderline cost-effective (US$ per DALY averted less than 3×GDP per capita of approximately US$ 40,000). The first was a scenario based primarily on the WHO 2008 pneumococcal disease burden estimates for Croatia. The second was a scenario that assumed a fairly dramatic drop in the price of the vaccine over the period. Both vaccines would need to be priced at approximately US$ 20 per dose or less to be considered cost-effective under base-case assumptions. PCV10 would be more cost-effective than PCV13 with base-case assumptions, but this is sensitive to the price of each vaccine.

CONCLUSION

Based on estimated health and economic benefits in children alone, PCV is unlikely to be cost-effective in Croatia. Both vaccines would need to be priced at less than US$ 20 per dose to be considered cost-effective for children. Further analyses should be conducted to estimate the health and economic burden of pneumococcal disease in older age groups, and to assess the influence on cost-effectiveness results when short-term and long-term indirect effects are included for older individuals. While there are important uncertainties around the price and effectiveness of both vaccines, our analysis suggests there is insufficient evidence to warrant a significant difference in the price of the two vaccines.

Authors+Show Affiliations

Croatian Institute of Public Health (CIPH), Department of Epidemiology, Croatia. Electronic address: vesna.visekruna@hzjz.hr.Croatian Institute of Public Health (CIPH), Department of Epidemiology, Croatia.Croatian Institute for Health Insurance (CIHI), Croatia.Ministry of Health of Republic of Croatia (MH), Croatia.London School of Hygiene and Tropical Medicine (LSHTM), UK.Agence de Médecine Préventive (AMP), France.Agence de Médecine Préventive (AMP), France.Agence de Médecine Préventive (AMP), France.Croatian Institute of Public Health (CIPH), Department of Epidemiology, Croatia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25919163

Citation

Vučina, V Višekruna, et al. "Cost-effectiveness of Pneumococcal Conjugate Vaccination in Croatia." Vaccine, vol. 33 Suppl 1, 2015, pp. A209-18.
Vučina VV, Filipović SK, Kožnjak N, et al. Cost-effectiveness of pneumococcal conjugate vaccination in Croatia. Vaccine. 2015;33 Suppl 1:A209-18.
Vučina, V. V., Filipović, S. K., Kožnjak, N., Stamenić, V., Clark, A. D., Mounaud, B., Blau, J., Hoestlandt, C., & Kaić, B. (2015). Cost-effectiveness of pneumococcal conjugate vaccination in Croatia. Vaccine, 33 Suppl 1, A209-18. https://doi.org/10.1016/j.vaccine.2014.12.043
Vučina VV, et al. Cost-effectiveness of Pneumococcal Conjugate Vaccination in Croatia. Vaccine. 2015 May 7;33 Suppl 1:A209-18. PubMed PMID: 25919163.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of pneumococcal conjugate vaccination in Croatia. AU - Vučina,V Višekruna, AU - Filipović,S Kurečić, AU - Kožnjak,N, AU - Stamenić,V, AU - Clark,A D, AU - Mounaud,B, AU - Blau,J, AU - Hoestlandt,C, AU - Kaić,B, PY - 2014/05/09/received PY - 2014/12/08/revised PY - 2014/12/09/accepted PY - 2015/4/29/entrez PY - 2015/4/29/pubmed PY - 2016/1/30/medline KW - Cost-effectiveness KW - Croatia KW - Decision-making KW - Evidence-based medicine KW - Pneumococcal KW - Vaccine SP - A209 EP - 18 JF - Vaccine JO - Vaccine VL - 33 Suppl 1 N2 - OBJECTIVE: Pneumococcus is a known cause of meningitis, pneumonia, sepsis, and acute otitis media in children and adults globally. Two new vaccines for children have the potential to prevent illness, disability, and death, but these vaccines are expensive. The Croatian Ministry of Health has considered introducing the vaccine in the past, but requires economic evidence to ensure that the limited funds available for health care will be used in the most effective way. METHODOLOGY: Croatia appointed a multidisciplinary team of experts to evaluate the cost-effectiveness of introducing pneumococcal conjugate vaccination (PCV) into the national routine child immunization program. Both 10-valent and 13-valent PCV (PCV10 and PCV13) were compared to a scenario assuming no vaccination. The TRIVAC decision-support model was used to estimate cost-effectiveness over the period 2014-2033. We used national evidence on demographics, pneumococcal disease incidence and mortality, the age distribution of disease in children, health service utilization, vaccine coverage, vaccine timeliness, and serotype coverage. Vaccine effectiveness was based on evidence from the scientific literature. Detailed health care costs were not available from the Croatian Institute for Health Insurance at the time of the analysis so assumptions and World Health Organization (WHO) estimates for Croatia were used. We assumed a three-dose primary vaccination schedule, and an initial price of US$ 30 per dose for PCV10 and US$ 35 per dose for PCV13. We ran univariate sensitivity analyses and multivariate scenario analyses. RESULTS: Either vaccine is estimated to prevent approximately 100 hospital admissions and one death each year in children younger than five in Croatia. Compared to no vaccine, the discounted cost-effectiveness of either vaccine is estimated to be around US$ 69,000-77,000 per disability-adjusted life-years (DALYs) averted over the period 2014-2033 (from the government or societal perspective). Only two alternative scenarios were borderline cost-effective (US$ per DALY averted less than 3×GDP per capita of approximately US$ 40,000). The first was a scenario based primarily on the WHO 2008 pneumococcal disease burden estimates for Croatia. The second was a scenario that assumed a fairly dramatic drop in the price of the vaccine over the period. Both vaccines would need to be priced at approximately US$ 20 per dose or less to be considered cost-effective under base-case assumptions. PCV10 would be more cost-effective than PCV13 with base-case assumptions, but this is sensitive to the price of each vaccine. CONCLUSION: Based on estimated health and economic benefits in children alone, PCV is unlikely to be cost-effective in Croatia. Both vaccines would need to be priced at less than US$ 20 per dose to be considered cost-effective for children. Further analyses should be conducted to estimate the health and economic burden of pneumococcal disease in older age groups, and to assess the influence on cost-effectiveness results when short-term and long-term indirect effects are included for older individuals. While there are important uncertainties around the price and effectiveness of both vaccines, our analysis suggests there is insufficient evidence to warrant a significant difference in the price of the two vaccines. SN - 1873-2518 UR - https://www.unboundmedicine.com/medline/citation/25919163/Cost_effectiveness_of_pneumococcal_conjugate_vaccination_in_Croatia_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0264-410X(14)01696-X DB - PRIME DP - Unbound Medicine ER -