Transcript Vaccination - VEGINFOR.org

Cost-effectiveness of pneumococcal
vaccination for older people: a study
in five western European countries
Ament A, Baltussen R, Duru G, Rigaud-Bully
C, De Graeve D, et al, Journal of infectious
diseases, Clinical Infectious Diseases, vol
31, nr 2, pp 444-50
Is vaccination a valuable preventive strategy?
Pneumococcal Pneumonia is a serious threat to our
health
 Treatment of Pneumococcal pneumonia is costly
 This is especially true in the elderly
 Vaccination can eliminate part of the clinical and
economic consequences of pneumococcal disease
 But it generates costs as well (vaccine,
administration, side-effects…)

Analyse the cost-effectiveness of vaccination

Restriction to invasive disease – Analysis
in five countries



Much better evidence of clinical protection of
the vaccine against invasive disease
Information on the cost-effectiveness of
vaccination in preventing invasive disease
could provide strong support for public
policies to provide strong support for public
policies to vaccinate older individuals
Belgium France, Scotland, Spain and
Sweden; same methodology, different data
Characteristics of the evaluation

Alternatives compared:


vaccination versus treatment of persons 64+ years
Measures of costs and effects



Costs (C): direct medical costs for society in € 1995
Effects (E): number of qualys gained
CE-ratio: C (Vaccination) - C (Treatment )
E (Vaccination) - E (Treatment)
Year 1
…year five
Country-specific, age specific
mortality rates
Table 1. Epidemiologic variables for invasive pneumococcal disease and pneumonia
Variable
Age groups (yrs)
Invasive pneumococcal disease*
Belgium
France
Scotland
Spain
Sweden
65-74
28.3
20.5
21.8
40.0
22.7
75-84
41.2
28.6
33.8
83.1
34.1
 85
65.4
67.7
62.9
74.5
49.2
 65
35.6
29.3
29.5
57.2
34.1
Incidence
(per 100,000)
Table 1. Epidemiologic variables for invasive pneumococcal disease and pneumonia
Invasive pneumococcal disease*
Variable
Age groups (yrs)
Belgium
France
Scotland
Spain
Sweden
Mortality (%)
§
65-74
12.8
§
18.9
24.5
§
8.0
75-84
19.9
§
20.6
40.0
§
22.7
§
12.9
 85
26.3
§
42.4
52.1
§
26.8
§
20.7
 65
19.3
§
25.8
37.9
§
17.6
§
11.7
6.3
Table 1. Epidemiologic variables for invasive pneumococcal disease and pneumonia
Variable
Age groups (yrs)
Invasive pneumococcal disease*
Belgium
France
Scotland
Spain
Sweden
¶
ALOS (days)
65-74
16.5
§
14.4
5.4
§
11.6
11.0
75-84
19.1
§
12.4
7.6
§
12.1
9.9
 85
20.7
§
11.8
9.4
§
9.8
10.7
 65
18.7
§
13.1
7.8
§
11.5
10.5
Table 2. Economic variables*
†
Costs
Belgium
France
Scotland
Spain
Sweden
Hospital care (per day)
267.6
330.4
304.6
206.0
332.4
Vaccine purchase
19.0
13.8
14.3
11.5
10.2
3.0
3.0
3.0
3.0
3.0
15.2
17.0
12.2
13.4
11.4
3.0
6.5
4.0
6.0
3
Vaccine administration
¶
Base case
Sensitivity analysis
††
Medical price index (%)
§§
Table 3. Results of the base case analyses
Age group
(yrs)
Invasive pneumococcal disease
Belgium France Scotland
Spain Sweden
65-74
21,685† 15,552 13.253
11,001 28,812
75-84
30,979
28,294 15.769
7,887
 85
68,339
27,841 27,464
40,657 68,744
 65
25,907
19,182 14,892
10,511 32,675
32,999
Table 3bis : Additional Costs and QALY per cohort;
base case Belgium + discount 5%
Age group
65-74 jaar
75-84 jaar
 85 jaar
 65 jaar
Discount 5%
Additional
Additional CECosts
QALYs
ratio
(ECU 1995)
17,523,598
808.092 21,685
8,588,305
277.230 35,979
3,230,929
47.278 68,339
29,342,832 1,132.599
30,391,423 973.458
25,907
31,220
Table 3bis : Additional Costs and QALY per cohort;
base case Belgium for 2002: vaccine price = €19;
hospital day = €486
Age group Additional
Additional CECosts
QALYs
ratio
(in ECU 2003)
65-74 jaar
14,393,527
808.092 17,812
75-84 jaar
7,379,890
277.230 26,620
2,953,944
47.278 62,480
 85 jaar
 65 jaar
24,727,361
1,132.599
21,832
Results of the sensitivity analyses
Belgium
France
Scotland Spain
Sweden
Base case†
25,907‡
19,182
14,892
10,511
32,675
Without influenza vaccination
43,106
37,886
23,422
20,013
57,314
30 / 100,000
29,593
15,217
13,645
23,774
31,123
40 / 100,000
21,003
10,633
9,975
17,101
21,821
50 / 100,000
15,849
7,883
7,773
13,097
16,240
20
19,796
19,904
23,135
7,342
15,024
30
13,197
13,269
15,423
4,895
10,016
40
9,898
9,951
11,566
3,671
7,512
Incidence of disease
(cases per 100,000  65 years)
Mortality (%)
Results of the sensitivity analyses
Belgium
France Scotland Spain
Sweden
25,907‡
19,182
14,892
10,511
32,675
current price – 3.00 ecus
21,678
15,174
12,110
7,770
23,875
current price + 3.00 ecus
30,136
23,190
17,673
13,252
41,474
best case
17,328
12,473
10,127
6,622
20,991
worst case
72,868
53,285
42,055
37,276
104,209
No quality-of-life adjustment 16,307
11,887
9,233
6,444
20,017
Discount rate, 0%
18,565
13,764
11,258
7,419
23,713
Discount rate, 5%
31,220
23,109
17,511
12,747
39,111
Base case†
Vaccine price
Vaccination effectiveness§
Conclusions



The results support recent recommendations
to vaccinate people aged 65 years and older
with Pneumococcal P.S. Vaccine
Even when only considering invasive disease,
this strategy is acceptably to moderately costeffective (less so for the very old)
Very reliable data on incidence and mortality
of S. pneumoniae would be good to convince
the sceptics