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The cost-effectiveness of pneumococcal conjugate vaccination in Australia

Butler, James; McIntyre, Peter; MacIntyre, C Raina; Gilmour, Robin; Howarth, Ann; Sander, B

Description

Background: Pneumococcal conjugate vaccine, 7 valent (PCV7) is the most costly vaccine yet considered for publicly funded programs. In mid 2001, Australia funded PCV7 for high-risk groups only (indigenous children and children with certain underlying medical conditions). World wide, non-industry-funded studies and studies using cost-utility measures are sparse. We undertook an independent economic analysis of PCV7 compared with no vaccination in the non high-risk Australian childhood population...[Show more]

dc.contributor.authorButler, James
dc.contributor.authorMcIntyre, Peter
dc.contributor.authorMacIntyre, C Raina
dc.contributor.authorGilmour, Robin
dc.contributor.authorHowarth, Ann
dc.contributor.authorSander, B
dc.date.accessioned2015-12-13T22:45:04Z
dc.date.available2015-12-13T22:45:04Z
dc.identifier.issn0264-410X
dc.identifier.urihttp://hdl.handle.net/1885/79585
dc.description.abstractBackground: Pneumococcal conjugate vaccine, 7 valent (PCV7) is the most costly vaccine yet considered for publicly funded programs. In mid 2001, Australia funded PCV7 for high-risk groups only (indigenous children and children with certain underlying medical conditions). World wide, non-industry-funded studies and studies using cost-utility measures are sparse. We undertook an independent economic analysis of PCV7 compared with no vaccination in the non high-risk Australian childhood population using cost-utility and cost-effectiveness measures. Methods: The incidence of invasive pneumococcal disease (IPD), non-bacteraemic pneumonia and otitis media was estimated using representative urban Australian data, or by extrapolation from comparable industrialised countries. A decision-analytic model was developed for a hypothetical birth cohort using the age-specific vaccine coverage from the Californian randomised controlled trial of PCV7. Health outcomes were measured by life-years saved and deaths and disability-adjusted life-years (DALYs) averted. In line with government guidelines, only direct costs were considered in 1997-1998 Australian dollars. Results: For a birth cohort of 250,000, the gross cost of vaccination is $ 78.6 million. Subtracting treatment cost savings, the net cost (discounted) is $ 61.7 million. In undiscounted terms, vaccination prevents 13.7 deaths, 11.2 (82%) from IPD and the remainder from non-bacteraemic pneumonia. The discounted cost per death avoided is $ 5.0 million, per life-year saved $ 230,130 and per DALY averted $ 121,100, giving a break-even vaccine price of $ 15.40 per dose. These estimates are most sensitive to the unit cost per dose of vaccine, estimates of incidence and vaccine efficacy against non-bacteraemic pneumonia and the discount rate. The cost per DALY reduced to $ 81,000 with a discount rate of 3% rather than 5% and to $ 90, 000 with the most favourable assumptions concerning pneumonia reduction. Discussion: With a vaccine price of $ 90 per dose, mid-range estimates of impact against non-bacteraemic pneumonia, and discount rate of 5%, a PCV7 program for infants not at high risk of IPD is at the upper limit of cost per DALY previously approved under Australian pharmaceutical funding guidelines. The impact of PCV7 against non-bacteraemic pneumonia is poorly defined, but its importance to cost-effectiveness in resource rich and resource poor settings warrants further studies or analysis to give greater precision to this outcome.
dc.publisherElsevier
dc.sourceVaccine
dc.subjectKeywords: heptavalent pneumococcal conjugate vaccine 7; Pneumococcus vaccine; unclassified drug; article; Australia; cohort analysis; controlled study; cost control; cost effectiveness analysis; cost utility analysis; death; disability; drug conjugation; drug effic Heptavalent pneumococcal conjugate vaccine; Invasive pneumococcal disease (IPD); Pneumonia
dc.titleThe cost-effectiveness of pneumococcal conjugate vaccination in Australia
dc.typeJournal article
local.description.notesImported from ARIES
local.description.refereedYes
local.identifier.citationvolume22
dc.date.issued2004
local.identifier.absfor140208 - Health Economics
local.identifier.ariespublicationMigratedxPub7993
local.type.statusPublished Version
local.contributor.affiliationButler, James, College of Medicine, Biology and Environment, ANU
local.contributor.affiliationMcIntyre, Peter, University of Sydney
local.contributor.affiliationMacIntyre, C Raina, Children's Hospital at Westmead
local.contributor.affiliationGilmour, Robin, University of Sydney
local.contributor.affiliationHowarth, Ann, College of Medicine, Biology and Environment, ANU
local.contributor.affiliationSander, B, College of Medicine, Biology and Environment, ANU
local.bibliographicCitation.startpage1138
local.bibliographicCitation.lastpage1149
local.identifier.doi10.1016/j.vaccine.2003.09.036
dc.date.updated2015-12-11T10:19:23Z
local.identifier.scopusID2-s2.0-1542270991
CollectionsANU Research Publications

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