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Cost-effectiveness analysis of universal adult immunization with tetanus-diphtheria-acellular pertussis vaccine (Tdap) versus current practice in Brazil. Vaccine 2019; 38:46-53. [PMID: 31648911 DOI: 10.1016/j.vaccine.2019.09.100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 09/30/2019] [Accepted: 09/30/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND A pertussis outbreak occurred in Brazil from 2011 to 2014, despite high coverage of whole-cell pertussis containing vaccines in early childhood. Infants were the most affected. This study aimed to evaluate the cost-effectiveness of introducing universal adult vaccination with Tdap into the National Immunization Program in Brazil. METHODS Economic evaluation using a dynamic model to compare two strategies: (1) universal vaccination with single dose of Tdap at 20 years of age and (2) current practice (only pregnant women pertussis vaccination). The health system perspective was adopted. Temporal horizon was 10 years. Discount rate of 5% was applied to costs and benefits. Vaccine effectiveness (VE) was obtained from a population-based observational study. Epidemiological, resource utilization and cost estimates were obtained from the Brazilian Health Information Systems. The primary outcome was cost per life year saved (LYS), based on life expectancy at birth in Brazil in 2015. Univariate and multivariate sensitivity analysis were performed. RESULTS Adult vaccination with VE of 82.6% and coverage of 40%, at price of US$7.01 per dose, and assuming herd protection would avoid 167 infant deaths by pertussis, saving 12,325 years of life and costing a total of US$105495891.61, from the health system perspective. The universal immunization would result in ICER of US$8459.13. The results were highly sensitive to disease incidence. CONCLUSIONS The results suggest that universal adult vaccination with Tdap would not be a cost-effective intervention for preventing pertussis cases and deaths in infants in Brazil.
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Fernandes EG, Rodrigues CCM, Sartori AMC, De Soárez PC, Novaes HMD. Economic evaluation of adolescents and adults' pertussis vaccination: A systematic review of current strategies. Hum Vaccin Immunother 2018; 15:14-27. [PMID: 30118618 PMCID: PMC6363086 DOI: 10.1080/21645515.2018.1509646] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The reemergence of pertussis in the last two decades led to the introduction of adolescents and adults immunization strategies of tetanus–diphtheria–acellular pertussis vaccines (Tdap) in several countries. The health authorities must consider economic aspects when deciding to recommend and fund new programs. Here we present a systematic review of worldwide full economic evaluations of pertussis vaccination targeting adolescents or adults published from 2000. Studies were identified by searching MEDLINE, Excerpta Medica, CRD, and Lilacs databases. Twenty-seven economic evaluations of different strategies with Tdap were identified. Booster vaccination for adolescents and adults were the most frequent, followed by cocooning and pregnant women vaccination. Strategies performance varied considerably among different studies. Assumptions regarding underreporting correction, herd protection and vaccine coverage were crucial to cost-effectiveness results. Understanding the model and the parameters used is essential to understand the results, and identify the major issues important to public health decisions.
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Affiliation(s)
- Eder Gatti Fernandes
- a Departamento de Medicina Preventiva , Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP , Brazil.,b Divisão de Imunização, Centro de Vigilância Epidemiológica "Prof. Alexandre Vranjac" , Coordenadoria de Controle de Doenças da Secretaria de Estado da Saúde de São Paulo , São Paulo , SP , Brazil
| | - Camila Cristina Martini Rodrigues
- c Departamento de Moléstias Infecciosas e Parasitárias , Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP , Brazil
| | - Ana Marli Christovam Sartori
- c Departamento de Moléstias Infecciosas e Parasitárias , Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP , Brazil
| | - Patrícia Coelho De Soárez
- a Departamento de Medicina Preventiva , Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP , Brazil
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Van Bellinghen LA, Dimitroff A, Haberl M, Li X, Manton A, Moeremans K, Demarteau N. Is adding maternal vaccination to prevent whooping cough cost-effective in Australia? Hum Vaccin Immunother 2018; 14:2263-2273. [PMID: 29771574 PMCID: PMC6183273 DOI: 10.1080/21645515.2018.1474315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Pertussis or whooping cough, a highly infectious respiratory infection, causes significant morbidity and mortality in infants. In adolescents and adults, pertussis presents with atypical symptoms often resulting in under-diagnosis and under-reporting, increasing the risk of transmission to more vulnerable groups. Maternal vaccination against pertussis protects mothers and newborns. This evaluation assessed the cost-effectiveness of adding maternal dTpa (reduced antigen diphtheria, Tetanus, acellular pertussis) vaccination to the 2016 nationally-funded pertussis program (DTPa [Diphtheria, Tetanus, acellular Pertussis] at 2, 4, 6, 18 months, 4 years and dTpa at 12–13 years) in Australia. A static cross-sectional population model was developed using a one-year period at steady-state. The model considered the total Australian population, stratified by age. Vaccine effectiveness against pertussis infection was assumed to be 92% in mothers and 91% in newborns, based on observational and case-control studies. The model included conservative assumptions around unreported cases. With 70% coverage, adding maternal vaccination to the existing pertussis program would prevent 8,847 pertussis cases, 422 outpatient cases, 146 hospitalizations and 0.54 deaths per year at the population level. With a 5% discount rate, 138.5 quality-adjusted life-years (QALYs) would be gained at an extra cost of AUS$ 4.44 million and an incremental cost-effectiveness ratio of AUS$ 32,065 per QALY gained. Sensitivity and scenario analyses demonstrated that outcomes were most sensitive to assumptions around vaccine effectiveness, duration of protection in mothers, and disutility of unreported cases. In conclusion, dTpa vaccination in the third trimester of pregnancy is likely to be cost-effective from a healthcare payer perspective in Australia.
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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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Kauhl B, Heil J, Hoebe CJPA, Schweikart J, Krafft T, Dukers-Muijrers NHTM. Is the current pertussis incidence only the results of testing? A spatial and space-time analysis of pertussis surveillance data using cluster detection methods and geographically weighted regression modelling. PLoS One 2017; 12:e0172383. [PMID: 28278180 PMCID: PMC5344341 DOI: 10.1371/journal.pone.0172383] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 02/03/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Despite high vaccination coverage, pertussis incidence in the Netherlands is amongst the highest in Europe with a shifting tendency towards adults and elderly. Early detection of outbreaks and preventive actions are necessary to prevent severe complications in infants. Efficient pertussis control requires additional background knowledge about the determinants of testing and possible determinants of the current pertussis incidence. Therefore, the aim of our study is to examine the possibility of locating possible pertussis outbreaks using space-time cluster detection and to examine the determinants of pertussis testing and incidence using geographically weighted regression models. METHODS We analysed laboratory registry data including all geocoded pertussis tests in the southern area of the Netherlands between 2007 and 2013. Socio-demographic and infrastructure-related population data were matched to the geo-coded laboratory data. The spatial scan statistic was applied to detect spatial and space-time clusters of testing, incidence and test-positivity. Geographically weighted Poisson regression (GWPR) models were then constructed to model the associations between the age-specific rates of testing and incidence and possible population-based determinants. RESULTS Space-time clusters for pertussis incidence overlapped with space-time clusters for testing, reflecting a strong relationship between testing and incidence, irrespective of the examined age group. Testing for pertussis itself was overall associated with lower socio-economic status, multi-person-households, proximity to primary school and availability of healthcare. The current incidence in contradiction is mainly determined by testing and is not associated with a lower socioeconomic status. DISCUSSION Testing for pertussis follows to an extent the general healthcare seeking behaviour for common respiratory infections, whereas the current pertussis incidence is largely the result of testing. More testing would thus not necessarily improve pertussis control. Detecting outbreaks using space-time cluster detection is feasible but needs to adjust for the strong impact of testing on the detection of pertussis cases.
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Affiliation(s)
- Boris Kauhl
- Department of Health, Ethics and Society, School of Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences. Maastricht University, Maastricht, the Netherlands
| | - Jeanne Heil
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service (GGD Zuid Limburg), Geleen, The Netherlands
- Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Christian J. P. A. Hoebe
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service (GGD Zuid Limburg), Geleen, The Netherlands
- Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Jürgen Schweikart
- Beuth University of Applied Sciences, Department III, Civil Engineering and Geoinformatics, Berlin, Germany
| | - Thomas Krafft
- Department of Health, Ethics and Society, School of Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences. Maastricht University, Maastricht, the Netherlands
| | - Nicole H. T. M. Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service (GGD Zuid Limburg), Geleen, The Netherlands
- Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
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Luttjeboer J, Setiawan D, Cao Q, Cahh Daemen T, Postma MJ. Threshold cost-effectiveness analysis for a therapeutic vaccine against HPV-16/18-positive cervical intraepithelial neoplasia in the Netherlands. Vaccine 2016; 34:6381-6387. [PMID: 27816370 DOI: 10.1016/j.vaccine.2016.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 10/10/2016] [Accepted: 10/13/2016] [Indexed: 11/28/2022]
Abstract
In this study, the potential price for a therapeutic vaccine against Human Papilloma Virus (HPV)-16 & 18 (pre)-malignant cervical lesions is examined. A decision tree model was built in the context of the new Dutch cervical cancer-screening program and includes a primary test for the presence of HPV. Based on data of cervical cancer screening and HPV prevalence in the Netherlands, cohorts were created with HPV-16 or 18 positive women with cervical intraepithelial neoplasia (CIN) 2 or 3 or cervical cancer stage 1A (FIGO 1A). In the base case, the vaccine price was based on equal numbers of effective treatments in the vaccine branch and the current treatments branch of the model, and parity in cost, i.e. total cost in both branches are the same. The vaccine price is calculated by subtracting the cost of the vaccine branch from cost in the standard treatment branch and divided by the total number of women in the cohort, thereby equalizing costs in both strategies. Scenario analyses were performed taking quality adjusted life years (QALYs) into account with €20,000/QALY, €50,000/QALY and €80,000/QALY as corresponding thresholds. Sensitivity analyses were specifically targeted at the characteristics of the type-specific HPV test in the screening practice and vaccine efficacy. A probabilistic sensitivity analysis (PSA) was performed to quantify the level of uncertainty of the results found in the base case. In the base case, break-even vaccine prices of €381, €568 and €1697 were found for CIN 2, CIN 3 and FIGO 1A, respectively. The PSA showed vaccine pricing below €310, €490 and €1660 will be cost saving with a likelihood of 95% for CIN 2, CIN 3 and FIGO 1A, respectively. The vaccine price proved to be very sensitive for inclusion of QALY gains, including the HPV-type specific test into the Dutch screening practice and vaccine efficacy.
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Affiliation(s)
- Jos Luttjeboer
- Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), University of Groningen, Groningen, The Netherlands.
| | - Didik Setiawan
- Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), University of Groningen, Groningen, The Netherlands
| | - Qi Cao
- Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), University of Groningen, Groningen, The Netherlands
| | - Toos Cahh Daemen
- Department of Medical Microbiology, Tumor Virology and Cancer Immunotherapy, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Maarten J Postma
- Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), University of Groningen, Groningen, The Netherlands; Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Institute of Science in Healthy Aging & healthcaRE (SHARE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Herdman M, Cole A, Hoyle CK, Coles V, Carroll S, Devlin N. Sources and Characteristics of Utility Weights for Economic Evaluation of Pediatric Vaccines: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:255-266. [PMID: 27021761 DOI: 10.1016/j.jval.2015.11.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 07/31/2015] [Accepted: 11/04/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Cost-effectiveness analysis of pediatric vaccines for infectious diseases often requires quality-of-life (utility) weights. OBJECTIVE To investigate how utility weights have been elicited and used in this context. METHODS A systematic review was conducted of studies published between January 1990 and July 2013 that elicited or used utility weights in cost-effectiveness analyses of vaccines for pediatric populations. The review focused on vaccines for 17 infectious diseases and is presented following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. RESULTS A total of 6410 titles and abstracts and 225 full-text articles were reviewed. Of those selected for inclusion (n = 101), 15 articles described the elicitation of utility weights and 86 described economic modeling studies using utilities. Various methods were used to generate utilities, including time trade-off, contingent valuation, and willingness to pay, as well as a preference-based measure with associated value sets, such as the EuroQol five-dimensional questionnaire or the Health Utilities Index. In modeling studies, the source of utilities used was often unclear, poorly reported, or based on weak underlying evidence. We found no articles that reported on the elicitation or use of utilities in diphtheria, polio, or tetanus. CONCLUSIONS The scarcity of appropriate utility weights for vaccine-preventable infectious diseases in children and a lack of standardization in their use in economic assessments limit the ability to accurately assess the benefits associated with interventions to prevent infectious diseases. This is an issue that should be of concern to those making decisions regarding the prevention and treatment of infectious childhood illnesses.
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Fernández-Cano MI, Armadans Gil L, Campins Martí M. Cost–benefit of the introduction of new strategies for vaccination against pertussis in Spain: Cocooning and pregnant vaccination strategies. Vaccine 2015; 33:2213-2220. [DOI: 10.1016/j.vaccine.2015.03.045] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/10/2015] [Accepted: 03/16/2015] [Indexed: 10/23/2022]
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De Cao E, Melegaro A, Klok R, Postma M. Optimising assessments of the epidemiological impact in The Netherlands of paediatric immunisation with 13-valent pneumococcal conjugate vaccine using dynamic transmission modelling. PLoS One 2014; 9:e89415. [PMID: 24694656 PMCID: PMC3973563 DOI: 10.1371/journal.pone.0089415] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 01/21/2014] [Indexed: 11/26/2022] Open
Abstract
This work is the first attempt to quantify the overall effects of a 13-valent pneumococcal conjugate vaccine (PCV13) vaccination programme in the Dutch population taking into account all the direct and indirect effects of the vaccine on invasive pneumococcal disease. Using available Dutch data, a dynamic transmission model for the spread of pneumococci and potential subsequent invasive pneumococcal disease has been adapted to the Dutch setting. Overall, invasive pneumococcal disease cases in the Netherlands are predicted to decrease from a pre-vaccination level of 2623 cases annually to 2475, 2289, 2185, 2179, and 2178 cases annually 5-, 10-, 20-, 30-, and 40-years, respectively, post-vaccination. Therefore, vaccination with PCV13 in the Netherlands is predicted to lower invasive pneumococcal disease cases per year by up to 445 cases in the medium- to long-term. The results are quite robust for the sensitivity analyses performed on the parameters that regulate herd immunity and competition between vaccine and non-vaccine types.
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Affiliation(s)
- Elisabetta De Cao
- Department of Pharmacy, University of Groningen, Groningen, Netherlands
- Department of Economics, Econometrics and Finance, University of Groningen, Groningen, Netherlands
| | - Alessia Melegaro
- Policy Analysis and Public Management Department and Dondena Centre for Research on Social Dynamics, Bocconi University, Milan, Italy
| | - Rogier Klok
- Pfizer bv, Specialty Care Business Unit, Capelle a/d IJssel, Netherlands
| | - Maarten Postma
- Department of Pharmacy, University of Groningen, Groningen, Netherlands
- * E-mail:
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Rivero-Santana A, Cuéllar-Pompa L, Sánchez-Gómez LM, Perestelo-Pérez L, Serrano-Aguilar P. Effectiveness and cost-effectiveness of different immunization strategies against whooping cough to reduce child morbidity and mortality. Health Policy 2013; 115:82-91. [PMID: 24444703 DOI: 10.1016/j.healthpol.2013.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 10/30/2013] [Accepted: 12/19/2013] [Indexed: 10/25/2022]
Abstract
INTRODUCTION In the last years there has been a significant increase in reported cases of pertussis in developed countries, in spite of high rates of childhood immunization. Health institutions have recommended different vaccination strategies to reduce child morbidity and mortality: vaccination of adolescents and adults, pregnant women, people in contact with the newborn (cocoon strategy) and health care workers. The aim of this paper is to review the scientific evidence supporting these recommendations. METHODS Systematic review on the effectiveness and cost-effectiveness of the above strategies for the reduction of morbidity and mortality from pertussis in infants under 12 months. The electronic databases Medline, PreMedline, Embase, CRD, Cochrane Central, and Trip Database were consulted from 1990 to October 2012. The evidence was assessed using the GRADE system. RESULTS There were eight studies on the efficacy or safety of the strategies analyzed, and 18 economic evaluations. Direct evidence on the efficacy of these strategies is scarce. Economic evaluations suggest that vaccination of adolescents and adults would be cost-effective, although there is major uncertainty over the parameters used. CONCLUSIONS From the perspective of health technology assessment, there is insufficient evidence to recommend the vaccination strategies evaluated.
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Affiliation(s)
- Amado Rivero-Santana
- Canarian Foundation of Health and Research (FUNCIS), Camino Candelaria, n° 44, 1ª planta, El Rosario, 38109 Tenerife, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain; Center for Biomedical Research of the Canary Islands (CIBICAN), Campus de Ciencias de la Salud, s/n, 38071 La Laguna, Spain.
| | - Leticia Cuéllar-Pompa
- Canarian Foundation of Health and Research (FUNCIS), Camino Candelaria, n° 44, 1ª planta, El Rosario, 38109 Tenerife, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain; Center for Biomedical Research of the Canary Islands (CIBICAN), Campus de Ciencias de la Salud, s/n, 38071 La Laguna, Spain
| | - Luis M Sánchez-Gómez
- Health Services Research on Chronic Patients Network (REDISSEC), Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain; Health Technology Assessment Agency (AETS), Health Institute Carlos III (ISCIII), C/Sinesio Delgado, 4, 28029 Madrid, Spain; Health Research Institute of the University Hospital La Princesa, C/ Diego León, 62, 28006 Madrid, Spain
| | - Lilisbeth Perestelo-Pérez
- Canarian Foundation of Health and Research (FUNCIS), Camino Candelaria, n° 44, 1ª planta, El Rosario, 38109 Tenerife, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain; Center for Biomedical Research of the Canary Islands (CIBICAN), Campus de Ciencias de la Salud, s/n, 38071 La Laguna, Spain; Evaluation Unit of the Canary Islands Health Service (SESCS), Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain
| | - Pedro Serrano-Aguilar
- Canarian Foundation of Health and Research (FUNCIS), Camino Candelaria, n° 44, 1ª planta, El Rosario, 38109 Tenerife, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain; Center for Biomedical Research of the Canary Islands (CIBICAN), Campus de Ciencias de la Salud, s/n, 38071 La Laguna, Spain; Evaluation Unit of the Canary Islands Health Service (SESCS), Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain
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Postma MJ, Westra TA, Quilici S, Largeron N. Economic evaluation of vaccines: specificities and future challenges illustrated by recent European examples. Expert Rev Vaccines 2013; 12:555-65. [PMID: 23659302 DOI: 10.1586/erv.13.36] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
This study reviews the current challenges in the economic evaluation of vaccines with a focus on European countries. In particular, the type of clinical evidence generally available, the impact of discounting for time preference and the use of modeling to derive valid cost-effectiveness assessments are considered. First, the characteristics of evidence for vaccines are discussed, as well as potential difficulties faced when using evidence-based medicine applied to curative drugs to interpret vaccine evidence. Then, discounting is considered and specific examples illustrating issues with different types of discounting are described, taking HPV as the example. Finally, the need for sometimes complex dynamic models for vaccines is explored, and specific types of models are reviewed, keeping into consideration the adage "complex when needed, straightforward if allowed."
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Affiliation(s)
- Maarten J Postma
- Unit of PharmacoEpidemiology and PharmacoEconomics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
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Lugnér AK, van der Maas N, van Boven M, Mooi FR, de Melker HE. Cost-effectiveness of targeted vaccination to protect new-borns against pertussis: comparing neonatal, maternal, and cocooning vaccination strategies. Vaccine 2013; 31:5392-7. [PMID: 24075918 DOI: 10.1016/j.vaccine.2013.09.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 09/03/2013] [Accepted: 09/13/2013] [Indexed: 11/19/2022]
Abstract
Pertussis (whooping cough) is a severe infectious disease in infants less than 6 months old. Mass vaccination programmes have been unable to halt transmission effectively. Strategies to protect new-borns against infection include vaccination of the neonate or the mother directly after birth (cocooning), or the mother during pregnancy (maternal). Here we investigate the cost-effectiveness of these three strategies in the Netherlands. Costs for health care utilization and productivity losses, as well as impact on quality of life were calculated for a 10-year vaccination programme, assuming that vaccine-induced immunity lasts 5 years. Cocooning was the most attractive option from a cost-effectiveness viewpoint (€89,000/QALY). However, both cocooning and maternal vaccination would reduce the disease burden in infants and mothers vaccinated (about 17-20 QALY/year). Specifically, with a persistent epidemic as seen in 2012, there is need for reconsidering the vaccination schedules against pertussis in order to increase protection of the vulnerable new-borns.
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Affiliation(s)
- Anna K Lugnér
- Epidemiology and Surveillance Unit, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
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Chiappini E, Stival A, Galli L, de Martino M. Pertussis re-emergence in the post-vaccination era. BMC Infect Dis 2013; 13:151. [PMID: 23530907 PMCID: PMC3623740 DOI: 10.1186/1471-2334-13-151] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 03/19/2013] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Resurgence of pertussis in the post-vaccination era has been reported in Western countries. A shift of cases from school-age children to adolescents, adults and children under 1 year of age has been described in the last decade, and mortality rates in infants are still sustained. We aimed to review and discuss the possible vaccination strategies which can be adopted in order to improve the pertussis control, by searches of Pubmed, and websites of US and European Centers for Disease Control and Prevention, between 1st January 2002, and 1st March 2013. DISCUSSION The following vaccination strategies have been retrieved and analysed: the cocooning strategy, the immunization of pregnant women and newborns, vaccination programs for preschool children, adolescents, adults and health-care workers. Cost-effectiveness studies provide some contrasting data, mainly supporting both maternal vaccination and cocooning. Adolescent and/or adult vaccination seems to be cost-effective, however data from observational studies suggest that this vaccination strategy, used alone, leads to a reduced pertussis burden globally, but does not affect the disease incidence in infants. Moreover, substantial logistical and economic difficulties have to be overcome to vaccinate the largest number of individuals. SUMMARY The simultaneous use of more than one strategy, including cocooning strategy plus vaccination of adolescents and adults, seems to be the most reasonable preventive measure. The development of new highly immunogenic and efficacious pertussis vaccines continues to be a primary objective for the control of pertussis.
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Affiliation(s)
- Elena Chiappini
- Anna Meyer University Hospital, Department of Health Sciences, University of Florence, Florence, Italy
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Re: Cost-effectiveness of pertussis booster vaccination in the Netherlands. Vaccine 2012; 30:7141. [DOI: 10.1016/j.vaccine.2012.09.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 09/10/2012] [Accepted: 09/17/2012] [Indexed: 11/21/2022]
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