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Perdrizet J, Farkouh RA, Horn EK, Hayford K, Sings HL, Wasserman MD. The broader impacts of otitis media and sequelae for informing economic evaluations of pneumococcal conjugate vaccines. Expert Rev Vaccines 2022; 21:499-511. [PMID: 35191368 DOI: 10.1080/14760584.2022.2040989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Otitis media (OM) is a common childhood infection. Pneumococcal conjugate vaccines (PCVs) prevent OM episodes, thereby reducing short- and long-term clinical, economic, humanistic, and societal consequences. Most economic evaluations of PCVs focus on direct health gains and cost savings from prevented acute episodes but do not fully account for the broader societal impacts of OM prevention. AREAS COVERED This review explores the broader burden of OM on children, caregivers, and society to better inform future economic evaluations of PCVs. EXPERT OPINION OM causes a substantial burden to society through long-term sequelae, productivity losses, reduced quality of life for children and caregivers, and contribution to antimicrobial resistance from inappropriate antibiotic use. The effect of PCVs on acute OM has been recognized globally, yet the broader impact has not been consistently quantified, studied, or communicated. Economic evaluations of PCVs must evolve to include broader effects for patients, caregivers, and society from OM prevention. Future PCVs with broader coverage may further reduce OM incidence and antimicrobial resistance, but optimal uptake will depend on increasing the recognition and use of novel frameworks that include broader benefits. Communicating the full value of PCVs to decision makers may result in wider access and positive societal returns.
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Affiliation(s)
- Johnna Perdrizet
- Health Economics and Outcomes Research, Pfizer Inc, New York, NY, USA
| | - Raymond A Farkouh
- Health Economics and Outcomes Research, Pfizer Inc, New York, NY, USA
| | - Emily K Horn
- Health Economics and Outcomes Research, Pfizer Inc, New York, NY, USA
| | - Kyla Hayford
- Vaccines Medical Development and Scientific and Clinical Affairs, Pfizer, Inc., Toronto, Canada
| | - Heather L Sings
- Vaccines Medical Development and Scientific and Clinical Affairs, Pfizer, Inc., Collegeville, PA, USA
| | - Matt D Wasserman
- Health Economics and Outcomes Research, Pfizer Inc, New York, NY, USA
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Shiri T, Khan K, Keaney K, Mukherjee G, McCarthy ND, Petrou S. Pneumococcal Disease: A Systematic Review of Health Utilities, Resource Use, Costs, and Economic Evaluations of Interventions. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:1329-1344. [PMID: 31708071 DOI: 10.1016/j.jval.2019.06.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 06/20/2019] [Accepted: 06/27/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Pneumococcal diseases cause substantial mortality, morbidity, and economic burden. Evidence on data inputs for economic evaluations of interventions targeting pneumococcal disease is critical. OBJECTIVES To summarize evidence on resource use, costs, health utilities, and cost-effectiveness for pneumococcal disease and associated interventions to inform future economic analyses. METHODS We searched MEDLINE, Embase, Web of Science, CINAHL, PsycINFO, EconLit, and Cochrane databases for peer-reviewed studies in English on pneumococcal disease that reported health utilities using direct or indirect valuation methods, resource use, costs, or cost-effectiveness of intervention programs, and summarized the evidence descriptively. RESULTS We included 383 studies: 9 reporting health utilities, 131 resource use, 160 economic costs of pneumococcal disease, 95 both resource use and costs, and 178 economic evaluations of pneumococcal intervention programs. Health state utility values ranged from 0 to 1 for both meningitis and otitis media and from 0.3 to 0.7 for both pneumonia and sepsis. Hospitalization was shortest for otitis media (range: 0.1-5 days) and longest for sepsis/septicemia (6-48). The main categories of costs reported were drugs, hospitalization, and household or employer costs. Resource use was reported in hospital length of stay and number of contacts with general practitioners. Costs and resource use significantly varied among population ages, disease conditions, and settings. Current vaccination programs for both adults and children, antibiotic use and outreach programs to promote vaccination, early disease detection, and educational programs are cost-effective in most countries. CONCLUSION This study has generated a comprehensive repository of health economic evidence on pneumococcal disease that can be used to inform future economic evaluations of pneumococcal disease intervention programs.
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Affiliation(s)
- Tinevimbo Shiri
- Liverpool School of Tropical Medicine, Liverpool, England, UK; Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, England, UK.
| | - Kamran Khan
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, England, UK
| | - Katherine Keaney
- Population Evidence and Technologies, Warwick Medical School, University of Warwick, England, UK
| | - Geetanjali Mukherjee
- Population Evidence and Technologies, Warwick Medical School, University of Warwick, England, UK
| | - Noel D McCarthy
- Population Evidence and Technologies, Warwick Medical School, University of Warwick, England, UK
| | - Stavros Petrou
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, England, UK; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England, UK
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Lavelle TA, D'Cruz BN, Mohit B, Ungar WJ, Prosser LA, Tsiplova K, Vera-Llonch M, Lin PJ. Family Spillover Effects in Pediatric Cost-Utility Analyses. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:163-174. [PMID: 30350218 DOI: 10.1007/s40258-018-0436-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
BACKGROUND Childhood illness can impose significant costs and health strains on family members, but these are not routinely captured by pediatric economic evaluations. This review investigated how family "spillover effects" related to costs and health outcomes are considered in pediatric cost-utility analyses (CUAs). METHODS We reviewed pediatric CUAs published between 2000 and 2015 using the Tufts Medical Center Cost-effectiveness Analysis (CEA) Registry and the Pediatric Economic Database Evaluation (PEDE) Registry. We selected studies conducted from the societal perspective and included in both registries. We investigated how frequently family spillover was incorporated into analyses, and how the inclusion of spillover health effects and costs changed CUA results. RESULTS We found 142 pediatric CUAs meeting inclusion criteria. Of those, 105 (72%) considered either family spillover costs (n = 98 time costs, n = 33 out-of-pocket costs, n = 2 caregiver healthcare costs) or health outcomes (n = 15). Twenty-four studies included 43 pairs of incremental cost-effectiveness ratios (ICERs) with and without spillover. In 19 pairs of ICERs, adding spillover changed the ICER enough to cross a common cost-effectiveness threshold (i.e., $50,000/QALY, $100,000/QALY, $150,000/QALY; values are in 2016 US$). Incorporating spillover generally made interventions more cost-effective (n = 18; 42%), or did not change CUA results enough to cross a threshold (n = 24; 56%). Including family spillover reduced ICERs by 31% ($40,000/QALY) on average. CONCLUSION Most pediatric CUAs conducted from a societal perspective include family costs but fewer include family health effects. Inclusion of family spillover effects tends to make CUA results more favorable. Future pediatric CUAs should aim to more fully incorporate the family burden of illness.
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Affiliation(s)
- Tara A Lavelle
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, #63, Boston, MA, 02111, USA.
| | - Brittany N D'Cruz
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, #63, Boston, MA, 02111, USA
| | - Babak Mohit
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, #63, Boston, MA, 02111, USA
| | - Wendy J Ungar
- Program of Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Lisa A Prosser
- Child Health Evaluation and Research Unit, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Kate Tsiplova
- Program of Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | | | - Pei-Jung Lin
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, #63, Boston, MA, 02111, USA
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Nymark LS, Sharma T, Miller A, Enemark U, Griffiths UK. Inclusion of the value of herd immunity in economic evaluations of vaccines. A systematic review of methods used. Vaccine 2017; 35:6828-6841. [PMID: 29146380 DOI: 10.1016/j.vaccine.2017.10.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 10/04/2017] [Accepted: 10/12/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objectives of this review were to identify vaccine economic evaluations that include herd immunity and describe the methodological approaches used. METHODS We used Kim and Goldie's search strategy from a systematic review (1976-2007) of modelling approaches used in vaccine economic evaluations and additionally searched PubMed/MEDLINE and Embase for 2007-2015. Studies were classified according to modelling approach used. Methods for estimating herd immunity effects were described, in particular for the static models. RESULTS We identified 625 economic evaluations of vaccines against human-transmissible diseases from 1976 to 2015. Of these, 172 (28%) included herd immunity. While 4% of studies included herd immunity in 2001, 53% of those published in 2015 did this. Pneumococcal, human papilloma and rotavirus vaccines represented the majority of studies (63%) considering herd immunity. Ninety-five of the 172 studies utilised a static model, 59 applied a dynamic model, eight a hybrid model and ten did not clearly state which method was used. Relatively crude methods and assumptions were used in the majority of the static model studies. CONCLUSION The proportion of economic evaluations using a dynamic model has increased in recent years. However, 55% of the included studies used a static model for estimating herd immunity. Values from a static model can only be considered reliable if high quality surveillance data are incorporated into the analysis. Without this, the results are questionable and they should only be included in sensitivity analysis.
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Affiliation(s)
- Liv S Nymark
- Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000 Aarhus C, Denmark; Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serums Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Tarang Sharma
- Nordic Cochrane Centre, Rigshospitalet, Blegdamsvej 9, DK- 2100 Copenhagen Ø, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, 2200 København N, Denmark
| | | | - Ulrika Enemark
- Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000 Aarhus C, Denmark; Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serums Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark
| | - Ulla Kou Griffiths
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK; UNICEF, 3 UN Plaza, New York, NY 10007, USA
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Zhang XH, Leeuwenkamp O, Oh KB, Lee YE, Kim CM. Cost-effectiveness analysis of infant pneumococcal vaccination with PHiD-CV in Korea. Hum Vaccin Immunother 2017; 14:85-94. [PMID: 29115905 PMCID: PMC5791581 DOI: 10.1080/21645515.2017.1362513] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Streptococcus pneumoniae and non-typeable Haemophilus influenzae (NTHi) can cause invasive pneumococcal diseases (IPD), pneumonia, and acute otitis media (AOM). Both the 10-valent pneumococcal NTHi protein D conjugate vaccine (PHiD-CV) and the 13-valent pneumococcal conjugate vaccine (PCV-13) are included in the National Immunization Program for infants in Korea. This study aimed to evaluate the cost-effectiveness of the 3+1 schedule of PHiD-CV versus that of PCV-13 for National Immunization Program in Korea. Methods: A published Markov model was adapted to evaluate the cost-effectiveness of vaccinating the 2012 birth cohort with PHiD-CV vs. PCV-13 from the Korean government perspective over 10 y. Best available published data were used for epidemiology, vaccine efficacy and disutilities. Data on incidence and direct medical costs were taken from the national insurance claims database. Sensitivity analyses were conducted to explore the robustness of the results. Results: PHiD-CV was projected to prevent an additional 195,262 cases of pneumococcal diseases and NTHi-related diseases vs. PCV-13, with a substantially greater reduction in NTHi-related AOM and a comparable reduction in IPD and community-acquired pneumonia. Parity-priced PHiD-CV generated a health gain of about 844 quality-adjusted life years and a total cost-saving of approximately 4 million United States Dollars (USD) over 10 y. 93% of probabilistic simulations found PHiD-CV 3+1 to be the dominant vaccine option. Conclusion: Compared to PCV-13, PHiD-CV was projected to provide similar prevention against IPD and community-acquired pneumonia but would prevent more cases of AOM. Parity-priced PHiD-CV was anticipated to generate substantial cost-savings and health benefits vs. PCV-13 in Korea.
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Affiliation(s)
| | | | | | | | - Chul-Min Kim
- e Department of Family Medicine , The Catholic University, Seoul St. Mary Hospital , Seoul , Korea
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Holubar M, Stavroulakis MC, Maldonado Y, Ioannidis JPA, Contopoulos-Ioannidis D. Impact of vaccine herd-protection effects in cost-effectiveness analyses of childhood vaccinations. A quantitative comparative analysis. PLoS One 2017; 12:e0172414. [PMID: 28249046 PMCID: PMC5332092 DOI: 10.1371/journal.pone.0172414] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 01/20/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Inclusion of vaccine herd-protection effects in cost-effectiveness analyses (CEAs) can impact the CEAs-conclusions. However, empirical epidemiologic data on the size of herd-protection effects from original studies are limited. METHODS We performed a quantitative comparative analysis of the impact of herd-protection effects in CEAs for four childhood vaccinations (pneumococcal, meningococcal, rotavirus and influenza). We considered CEAs reporting incremental-cost-effectiveness-ratios (ICERs) (per quality-adjusted-life-years [QALY] gained; per life-years [LY] gained or per disability-adjusted-life-years [DALY] avoided), both with and without herd protection, while keeping all other model parameters stable. We calculated the size of the ICER-differences without vs with-herd-protection and estimated how often inclusion of herd-protection led to crossing of the cost-effectiveness threshold (of an assumed societal-willingness-to-pay) of $50,000 for more-developed countries or X3GDP/capita (WHO-threshold) for less-developed countries. RESULTS We identified 35 CEA studies (20 pneumococcal, 4 meningococcal, 8 rotavirus and 3 influenza vaccines) with 99 ICER-analyses (55 per-QALY, 27 per-LY and 17 per-DALY). The median ICER-absolute differences per QALY, LY and DALY (without minus with herd-protection) were $15,620 (IQR: $877 to $48,376); $54,871 (IQR: $787 to $115,026) and $49 (IQR: $15 to $1,636) respectively. When the target-vaccination strategy was not cost-saving without herd-protection, inclusion of herd-protection always resulted in more favorable results. In CEAs that had ICERs above the cost-effectiveness threshold without herd-protection, inclusion of herd-protection led to crossing of that threshold in 45% of the cases. This impacted only CEAs for more developed countries, as all but one CEAs for less developed countries had ICERs below the WHO-cost-effectiveness threshold even without herd-protection. In several analyses, recommendation for the adoption of the target vaccination strategy depended on the inclusion of the herd protection effect. CONCLUSIONS Inclusion of herd-protection effects in CEAs had a substantial impact in the estimated ICERs and made target-vaccination strategies more attractive options in almost half of the cases where ICERs were above the societal-willingness to pay threshold without herd-protection. More empirical epidemiologic data are needed to determine the size of herd-protection effects across diverse settings and also the size of negative vaccine effects, e.g. from serotype substitution.
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Affiliation(s)
- Marisa Holubar
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - Maria Christina Stavroulakis
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai/ Elmhurst Hospital Center, New York, New York, United States of America
| | - Yvonne Maldonado
- Department of Pediatrics, Division of Pediatric Infectious Diseases and Department of Health Research and Policy, Senior Associate Dean for Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California, United States of America
| | - John P. A. Ioannidis
- Stanford Prevention Research Center, Department of Medicine and Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, United States of America
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, United States of America
| | - Despina Contopoulos-Ioannidis
- Department of Pediatrics, Division of Pediatric Infectious Diseases and Department of Health Research and Policy, Senior Associate Dean for Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California, United States of America
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, United States of America
- * E-mail:
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Moore MR, Whitney CG. Use of Pneumococcal Disease Epidemiology to Set Policy and Prevent Disease during 20 Years of the Emerging Infections Program. Emerg Infect Dis 2016; 21:1551-6. [PMID: 26291238 PMCID: PMC4550168 DOI: 10.3201/eid2109.150395] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
This program has been a flexible platform for following trends of this disease and evaluating vaccine effectiveness. Two decades ago, the Emerging Infections Program of the US Centers for Disease Control and Prevention implemented what seemed like a simple yet novel idea: a population- and laboratory-based surveillance system designed to identify and characterize invasive bacterial infections, including those caused by Streptococcus pneumoniae. This system, known as Active Bacterial Core surveillance, has since served as a flexible platform for following trends in invasive pneumococcal disease and studying vaccination as the most effective method for prevention. We report the contributions of Active Bacterial Core surveillance to every pneumococcal vaccine policy decision in the United States during the past 20 years.
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Wu DBC, Chaiyakunapruk N, Chong HY, Beutels P. Choosing between 7-, 10- and 13-valent pneumococcal conjugate vaccines in childhood: a review of economic evaluations (2006-2014). Vaccine 2015; 33:1633-58. [PMID: 25681663 DOI: 10.1016/j.vaccine.2015.01.081] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 01/11/2015] [Accepted: 01/30/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND Seven-valent pneumococcal conjugate vaccines (PCV7) have been used in children for more than a decade. Given the observed increase in disease caused by pneumococcal serotypes not covered by PCV7, an increasing number of countries are switching from 7-valent to 10- and 13-valent PCVs ("PCV10" and "PCV13"). Economic evaluations are important tools to inform decisions and price negotiations to make such a switch. OBJECTIVE This review aims to provide a critical assessment of economic evaluations involving PCV10 or PCV13, published since 2006. METHODS We searched Scopus, ISI Web of Science (SCI and SSCI) and Pubmed to retrieve, select and review relevant studies, which were archived between 1st January 2006 and 31st January 2014. The review protocol involved standard extraction of assumptions, methods, results and sponsorships from the original studies. RESULTS Sixty-three economic evaluations on PCVs published since January 2006 were identified. About half of these evaluated PCV10 and/or PCV13, the subject of this review. At current prices, both PCV13 and PCV10 were likely judged preferable to PCV7. However, the combined uncertainty related to price differences, burden of disease, vaccine effectiveness, herd and serotype replacement effects determine the preference base for either PCV10 or PCV13. The pivotal assumptions and results of these analyses also depended on which manufacturer sponsored the study. CONCLUSION A more thorough exploration of uncertainty should be made in future analyses on this subject, as we lack understanding to adequately model herd and serotype replacement effects to reliably predict the population impact of PCVs. The introduction of further improved PCVs in an environment of evolving antibiotic resistance and under the continuing influence of previous PCVs implies that the complexity and data requirements for relevant analyses will further increase. Decision makers using these analyses should not just rely on an analysis from a single manufacturer.
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Affiliation(s)
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University Malaysia, Malaysia; Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; School of Pharmacy, University of Wisconsin, Madison, USA; School of Population Health, University of Queensland, Brisbane, Australia.
| | - Huey-Yi Chong
- School of Pharmacy, Monash University Malaysia, Malaysia.
| | - Philippe Beutels
- Centre for Health Economics Research & Modelling Infectious Diseases, Vaccine & Infectious Disease Institute, WHO Collaborating Centre, Faculty of Medicine & Health Sciences, University of Antwerp, Belgium; School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia.
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De la Hoz-Restrepo F, Castañeda-Orjuela C, Paternina A, Alvis-Guzman N. Systematic review of incremental non-vaccine cost estimates used in cost-effectiveness analysis on the introduction of rotavirus and pneumococcal vaccines. Vaccine 2014; 31 Suppl 3:C80-7. [PMID: 23777697 DOI: 10.1016/j.vaccine.2013.05.064] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 05/01/2013] [Accepted: 05/15/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To review the approaches used in the cost-effectiveness analysis (CEAs) literature to estimate the cost of expanded program on immunization (EPI) activities, other than vaccine purchase, for rotavirus and pneumococcal vaccines. METHODS A systematic review in PubMed and NHS EED databases of rotavirus and pneumococcal vaccines CEAs was done. Selected articles were read and information on how EPI costs were calculated was extracted. EPI costing approaches were classified according to the method or assumption used for estimation. RESULTS Seventy-nine studies that evaluated cost effectiveness of rotavirus (n=43) or pneumococcal (n=36) vaccines were identified. In general, there are few details on how EPI costs other than vaccine procurement were estimated. While 30 studies used some measurement of that cost, only one study on pneumococcal vaccine used a primary cost evaluation (bottom-up costing analysis) and one study used a costing tool. Twenty-seven studies (17 on rotavirus and 10 on pneumococcal vaccine) assumed the non-vaccine costs. Five studies made no reference to additional costs. Fourteen studies (9 rotavirus and 5 pneumococcal) did not consider any additional EPI cost beyond vaccine procurement. For rotavirus studies, the median for non-vaccine cost per dose was US$0.74 in developing countries and US$6.39 in developed countries. For pneumococcal vaccines, the median for non-vaccine cost per dose was US$1.27 in developing countries and US$8.71 in developed countries. CONCLUSIONS Many pneumococcal (52.8%) and rotavirus (60.4%) cost-effectiveness analyses did not consider additional EPI costs or used poorly supported assumptions. Ignoring EPI costs in addition to those for vaccine procurement in CEA analysis of new vaccines may lead to significant errors in the estimations of ICERs since several factors like personnel, cold chain, or social mobilization can be substantially affected by the introduction of new vaccines.
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Grosse SD, Prosser LA, Asakawa K, Feeny D. QALY weights for neurosensory impairments in pediatric economic evaluations: case studies and a critique. Expert Rev Pharmacoecon Outcomes Res 2014; 10:293-308. [DOI: 10.1586/erp.10.24] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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van de Vooren K, Duranti S, Curto A, Garattini L. Cost effectiveness of the new pneumococcal vaccines: a systematic review of European studies. PHARMACOECONOMICS 2014; 32:29-45. [PMID: 24288207 DOI: 10.1007/s40273-013-0113-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Diseases caused by Streptococcus pneumoniae (pneumococcus) are a major global public health problem. Despite their importance, information on the burden of the different pneumococcal diseases is limited and estimates vary widely. OBJECTIVE AND METHODS We critically reviewed the full economic evaluations (FEEs) on the new pneumococcal conjugate vaccines (PCVs) conducted in the European Union (EU) to assess their potential contribution to public decision making. We selected the FEEs focussed on PCV-10 and PCV-13 and published in English from January 2007 until June 2013. We screened the selected articles to assess their main methodological features using a common checklist composed of epidemiological, clinical and economic items. RESULTS All the ten studies selected were based on modelling and the time horizon was always long term. Two studies focused on adults, the remaining eight on infants. Only one study based herd immunity on national data, eight used foreign data or modelling and the last did not consider it. National prices and tariffs were claimed to be sources for unit costs in all studies; however, half of them assumed price parity when one vaccine was not yet marketed, and the figures varied within the countries where more than one study was conducted. Conclusions supported the economic utility of pneumococcal vaccination in all studies, raising some concern only in (i) the independent study, which found that PCV-13 was borderline cost effective, and (ii) the study sponsored by both manufacturers, which estimated an incremental ratio slightly above the national threshold for both PCV-10 and PCV-13. CONCLUSION The European studies we analysed are mostly based on weak sources of data. Because of the limited information on vaccine effectiveness and lack of epidemiological and economic data, the need for extensive recourse to assumptions leads to great within- and between-study variability generated by authors' choices.
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Affiliation(s)
- Katelijne van de Vooren
- CESAV, Centre for Health Economics, IRCCS Institute for Pharmacological Research 'Mario Negri', Via Camozzi, 3 c/o Villa Camozzi, Ranica, 24020, Bergamo, Italy
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Kulpeng W, Leelahavarong P, Rattanavipapong W, Sornsrivichai V, Baggett HC, Meeyai A, Punpanich W, Teerawattananon Y. Cost-utility analysis of 10- and 13-valent pneumococcal conjugate vaccines: protection at what price in the Thai context? Vaccine 2013; 31:2839-47. [PMID: 23588084 PMCID: PMC4667720 DOI: 10.1016/j.vaccine.2013.03.047] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 01/02/2013] [Accepted: 03/28/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This study aims to evaluate the costs and outcomes of offering the 10-valent pneumococcal conjugate vaccine (PCV10) and 13-valent pneumococcal conjugate vaccine (PCV13) in Thailand compared to the current situation of no PCV vaccination. METHODS Two vaccination schedules were considered: two-dose primary series plus a booster dose (2+1) and three-dose primary series plus a booster dose (3+1). A cost-utility analysis was conducted using a societal perspective. A Markov simulation model was used to estimate the relevant costs and health outcomes for a lifetime horizon. Costs were collected and values were calculated for the year 2010. The results were reported as incremental cost-effectiveness ratios (ICERs) in Thai Baht (THB) per quality adjusted life year (QALY) gained, with future costs and outcomes being discounted at 3% per annum. One-way sensitivity analysis and probabilistic sensitivity analysis using a Monte Carlo simulation were performed to assess parameter uncertainty. RESULTS Under the base case-scenario of 2+1 dose schedule and a five-year protection, without indirect vaccine effects, the ICER for PCV10 and PCV13 were THB 1,368,072 and THB 1,490,305 per QALY gained, respectively. With indirect vaccine effects, the ICER of PCV10 was THB 519,399, and for PCV13 was THB 527,378. The model was sensitive to discount rate, the change in duration of vaccine protection and the incidence of pneumonia for all age groups. CONCLUSIONS At current prices, PCV10 and PCV13 are not cost-effective in Thailand. Inclusion of indirect vaccine effects substantially reduced the ICERs for both vaccines, but did not result in cost effectiveness.
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Affiliation(s)
- Wantanee Kulpeng
- Health Intervention and Technology Assessment Program (HITAP), 6th Floor, 6th Building, Department of Health, Ministry of Public Health, Tiwanon Rd., Muang, Nonthaburi 11000, Thailand.
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Pitman R, Fisman D, Zaric GS, Postma M, Kretzschmar M, Edmunds J, Brisson M. Dynamic transmission modeling: a report of the ISPOR-SMDM Modeling Good Research Practices Task Force Working Group-5. Med Decis Making 2013; 32:712-21. [PMID: 22990086 DOI: 10.1177/0272989x12454578] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The transmissible nature of communicable diseases is what sets them apart from other diseases modeled by health economists. The probability of a susceptible individual becoming infected at any one point in time (the force of infection) is related to the number of infectious individuals in the population, will change over time, and will feed back into the future force of infection. These nonlinear interactions produce transmission dynamics that require specific consideration when modeling an intervention that has an impact on the transmission of a pathogen. Best practices for designing and building these models are set out in this paper.
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Affiliation(s)
| | - David Fisman
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (DF)
| | - Gregory S Zaric
- Ivey School of Business, University of Western Ontario, London, Canada (GSZ)
| | - Maarten Postma
- Unit of PharmacoEpidemiology and PharmacoEconomics, Department of Pharmacy, University of Groningen, Groningen, Netherlands (MP)
| | - Mirjam Kretzschmar
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, and Center for Infectious Disease Control, RIVM, Bilthoven, Netherlands (MK)
| | - John Edmunds
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine,
London, United Kingdom (JE)
| | - Marc Brisson
- URESP, Centre de Recherche FRSQ du CHA Universitaire de Que´ bec and De´ partement de Me´ decine Sociale et Pre´ ventive, Laval University, Quebec City, Canada (MB)
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Jackowska T, Zaleska-Ponganis J, Dziurda D. Invasive Pneumococcal Bacteremia in a 9-Year-Old Boy Caused by Serotype 1: Course, Treatment and Costs. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2013; 755:257-66. [DOI: 10.1007/978-94-007-4546-9_33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lucarevschi BR, Escobar AMDU, Grisi S. [Hospital costs related to streptococcal meningitis among children in São José dos Campos, São Paulo State, Brazil]. CAD SAUDE PUBLICA 2012; 28:740-8. [PMID: 22488319 DOI: 10.1590/s0102-311x2012000400013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Accepted: 11/23/2011] [Indexed: 11/22/2022] Open
Abstract
Knowledge of hospital costs is highly important for public health decision-making. This study aimed to estimate direct hospital costs related to pneumococcal meningitis in children 13 years or younger in the city of São José dos Campos, São Paulo State, Brazil, from January 1999 to December 2008. Data were obtained from medical records. Hospital costs were calculated according to the mixed method for measurement of quantities of items with identified costs and value attribution to items consumed (micro-costing and gross-costing). All costs were calculated according to monetary values for November 2009 and in Brazilian currency (Real). Epi Info 3.5.1 was used for frequencies and means analysis. Forty-one cases were reported. Direct hospital costs varied from R$ 1,277.90 to R$ 19,887.56 (mean = R$ 5,666.43), or 10 to 20 times the mean cost of hospitalization for other diseases. Hospital staff labor was the highest cost, followed by medication, procedures, supplies, and lab tests.
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Pitman R, Fisman D, Zaric GS, Postma M, Kretzschmar M, Edmunds J, Brisson M. Dynamic transmission modeling: a report of the ISPOR-SMDM Modeling Good Research Practices Task Force--5. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2012; 15:828-34. [PMID: 22999132 PMCID: PMC7110742 DOI: 10.1016/j.jval.2012.06.011] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 06/21/2012] [Indexed: 05/17/2023]
Abstract
The transmissible nature of communicable diseases is what sets them apart from other diseases modeled by health economists. The probability of a susceptible individual becoming infected at any one point in time (the force of infection) is related to the number of infectious individuals in the population, will change over time, and will feed back into the future force of infection. These nonlinear interactions produce transmission dynamics that require specific consideration when modeling an intervention that has an impact on the transmission of a pathogen. Best practices for designing and building these models are set out in this article.
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17
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Ibuka Y, Paltiel AD, Galvani AP. Impact of program scale and indirect effects on the cost-effectiveness of vaccination programs. Med Decis Making 2012; 32:442-6. [PMID: 22472916 DOI: 10.1177/0272989x12441397] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Yoko Ibuka
- Yale University School of Medicine, New Haven, CT, USA (YI, ADP, APG),Hitotsubashi University, Tokyo, Japan (YI)
| | - A David Paltiel
- Yale University School of Medicine, New Haven, CT, USA (YI, ADP, APG)
| | - Alison P Galvani
- Yale University School of Medicine, New Haven, CT, USA (YI, ADP, APG)
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By Å, Sobocki P, Forsgren A, Silfverdal SA. Comparing Health Outcomes and Costs of General Vaccination with Pneumococcal Conjugate Vaccines in Sweden: A Markov Model. Clin Ther 2012; 34:177-89. [DOI: 10.1016/j.clinthera.2011.12.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2011] [Indexed: 10/14/2022]
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Chaiyakunapruk N, Somkrua R, Hutubessy R, Henao AM, Hombach J, Melegaro A, Edmunds JW, Beutels P. Cost effectiveness of pediatric pneumococcal conjugate vaccines: a comparative assessment of decision-making tools. BMC Med 2011; 9:53. [PMID: 21569402 PMCID: PMC3117724 DOI: 10.1186/1741-7015-9-53] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 05/12/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Several decision support tools have been developed to aid policymaking regarding the adoption of pneumococcal conjugate vaccine (PCV) into national pediatric immunization programs. The lack of critical appraisal of these tools makes it difficult for decision makers to understand and choose between them. With the aim to guide policymakers on their optimal use, we compared publicly available decision-making tools in relation to their methods, influential parameters and results. METHODS The World Health Organization (WHO) requested access to several publicly available cost-effectiveness (CE) tools for PCV from both public and private provenance. All tools were critically assessed according to the WHO's guide for economic evaluations of immunization programs. Key attributes and characteristics were compared and a series of sensitivity analyses was performed to determine the main drivers of the results. The results were compared based on a standardized set of input parameters and assumptions. RESULTS Three cost-effectiveness modeling tools were provided, including two cohort-based (Pan-American Health Organization (PAHO) ProVac Initiative TriVac, and PneumoADIP) and one population-based model (GlaxoSmithKline's SUPREMES). They all compared the introduction of PCV into national pediatric immunization program with no PCV use. The models were different in terms of model attributes, structure, and data requirement, but captured a similar range of diseases. Herd effects were estimated using different approaches in each model. The main driving parameters were vaccine efficacy against pneumococcal pneumonia, vaccine price, vaccine coverage, serotype coverage and disease burden. With a standardized set of input parameters developed for cohort modeling, TriVac and PneumoADIP produced similar incremental costs and health outcomes, and incremental cost-effectiveness ratios. CONCLUSIONS Vaccine cost (dose price and number of doses), vaccine efficacy and epidemiology of critical endpoint (for example, incidence of pneumonia, distribution of serotypes causing pneumonia) were influential parameters in the models we compared. Understanding the differences and similarities of such CE tools through regular comparisons could render decision-making processes in different countries more efficient, as well as providing guiding information for further clinical and epidemiological research. A tool comparison exercise using standardized data sets can help model developers to be more transparent about their model structure and assumptions and provide analysts and decision makers with a more in-depth view behind the disease dynamics. Adherence to the WHO guide of economic evaluations of immunization programs may also facilitate this process. Please see related article: http://www.biomedcentral.com/1741-7007/9/55.
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Affiliation(s)
- Nathorn Chaiyakunapruk
- Center of Pharmaceutical Outcomes Research, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
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20
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Speets A, Wolleswinkel J, Cardoso C. Societal costs and burden of otitis media in Portugal. J Multidiscip Healthc 2011; 4:53-62. [PMID: 21544248 PMCID: PMC3084308 DOI: 10.2147/jmdh.s17529] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Indexed: 11/23/2022] Open
Abstract
This study aimed to estimate the resource consumption and societal impact of otitis media (OM) in children younger than five years of age in Portugal. An Internet survey on generic childhood symptoms and diseases was administered to a sample of parents. This self-report survey had been previously implemented in other European countries. Medically confirmed OM was defined as symptoms of earache or "running ear" and/or a diagnosis of OM provided by a medical doctor. Direct medical, nonmedical, and indirect nonmedical costs were calculated for individual cases. Mean total costs per OM episode were estimated at €334. This corresponds to an estimated societal impact of 72 million €/year, of which 39% were indirect nonmedical costs. An epidemiological study should help to confirm the results of this study, and evaluate whether an intervention to reduce the occurrence and/or duration of OM may have an impact on societal costs and quality of life for affected families.
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Affiliation(s)
- Anouk Speets
- Pallas health research and consultancy, Rotterdam, the Netherlands
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21
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Boonacker CWB, Broos PH, Sanders EAM, Schilder AGM, Rovers MM. Cost effectiveness of pneumococcal conjugate vaccination against acute otitis media in children: a review. PHARMACOECONOMICS 2011; 29:199-211. [PMID: 21250759 DOI: 10.2165/11584930-000000000-00000] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
While pneumococcal conjugate vaccines have shown to be highly effective against invasive pneumococcal disease, their potential effectiveness against acute otitis media (AOM) might become a major economic driver for implementing these vaccines in national immunization programmes. However, the relationship between the costs and benefits of available vaccines remains a controversial topic. Our objective is to systematically review the literature on the cost effectiveness of pneumococcal conjugate vaccination against AOM in children. We searched PubMed, Cochrane and the Centre for Reviews and Dissemination databases (Database of Abstracts of Reviews of Effects [DARE], NHS Economic Evaluation Database [NHS EED] and Health Technology Assessment database [HTA]) from inception until 18 February 2010. We used the following keywords with their synonyms: 'otitis media', 'children', 'cost-effectiveness', 'costs' and 'vaccine'. Costs per AOM episode averted were calculated based on the information in this literature. A total of 21 studies evaluating the cost effectiveness of pneumococcal conjugate vaccines were included. The quality of the included studies was moderate to good. The cost per AOM episode averted varied from &U20AC;168 to &U20AC;4214, and assumed incidence rates varied from 20,952 to 118,000 per 100,000 children aged 0-10 years. Assumptions regarding direct and indirect costs varied between studies. The assumed vaccine efficacy of the 7-valent pneumococcal CRM197-conjugate vaccine was mainly adopted from two trials, which reported 6-8% efficacy. However, some studies assumed additional effects such as herd immunity or only took into account AOM episodes caused by serotypes included in the vaccine, which resulted in efficacy rates varying from 12% to 57%. Costs per AOM episode averted were inversely related to the assumed incidence rates of AOM and to the estimated costs per AOM episode. The median costs per AOM episode averted tended to be lower in industry-sponsored studies. Key assumptions regarding the incidence and costs of AOM episodes have major implications for the estimated cost effectiveness of pneumococcal conjugate vaccination against AOM. Uniform methods for estimating direct and indirect costs of AOM should be agreed upon to reliably compare the cost effectiveness of available and future pneumococcal vaccines against AOM.
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Affiliation(s)
- Chantal W B Boonacker
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
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Speets AM, Wolleswinkel JH, Forsgren A, Sobocki PA. Use of medical resources and indirect costs of otitis media in Sweden. Scand J Public Health 2011; 39:137-46. [DOI: 10.1177/1403494810393553] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: To estimate the use of medical resources and the societal impact of otitis media (OM) in children less than five years of age in Sweden. Methods: An internet survey questionnaire was administered to a sample of parents with children <5 years of age. The survey covered socio-demographic data, characteristics of the OM episode, use of medical resources, productivity loss by the caregivers, and travel-related costs. Medical doctor confirmed OM (MD-OM) was defined as symptoms of earache or ‘‘running’’ ear, and/or a diagnosis of OM provided by a medical doctor. Results: Of all MD-OM episodes (n = 91), in 47% a general practitioner had been consulted, in 21% a paediatrician, and in 23% an emergency department had been visited. Hospital admission occurred in one case. The MD prescribed antibiotics in 85% and over the counter drugs were bought in 69% of the episodes. In 57% of the MD-OM episodes the caregivers lost days from a paid job (mean 30.3 hours per episode, SD 19.6). In 30% of the episodes, parents reported productivity loss at work during their child’s illness (mean 9.0 hours per episode, SD 12.4). The mean costs were estimated to be 6,385 SEK (575) per episode of MD-OM resulting in an economic burden to Sweden of 743,570,000 SEK (66,920,866). Fifty eight per cent of the costs were indirect non-medical costs. Conclusions: The medical and economic burden of OM is considerable to individual families as well as to society in Sweden. This study has filled a gap in the knowledge base on the impact of OM on society.
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Affiliation(s)
- Anouk M. Speets
- Pallas health research and consultancy BV, Rotterdam, The Netherlands,
| | | | | | - Patrik A. Sobocki
- Karolinska Institutet, Stockholm, Sweden, GlaxoSmithKline, Solna, Sweden
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Silfverdal SA, Berg S, Hemlin C, Jokinen I. The cost-burden of paediatric pneumococcal disease in Sweden and the potential cost-effectiveness of prevention using 7-valent pneumococcal vaccine. Vaccine 2009; 27:1601-8. [DOI: 10.1016/j.vaccine.2008.12.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2008] [Revised: 12/09/2008] [Accepted: 12/20/2008] [Indexed: 11/16/2022]
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