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Special Communication |

Projected Cost-effectiveness of Pneumococcal Conjugate Vaccination of Healthy Infants and Young Children

Tracy A. Lieu, MD, MPH; G. Thomas Ray, MBA; Steven B. Black, MD; Jay C. Butler, MD; Jerome O. Klein, MD; Robert F. Breiman, MD; Mark A. Miller, MD; Henry R. Shinefield, MD
JAMA. 2000;283(11):1460-1468. doi:10.1001/jama.283.11.1460.
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Context Pneumococcal conjugate vaccine for infants has recently been found effective against meningitis, bacteremia, pneumonia, and otitis media.

Objective To evaluate the projected health and economic impact of pneumococcal conjugate vaccination of healthy US infants and young children.

Design Cost-effectiveness analysis based on data from the Northern California Kaiser Permanente randomized trial and other published and unpublished sources.

Setting and Patients A hypothetical US birth cohort of 3.8 million infants.

Interventions Hypothetical comparisons of routine vaccination of healthy infants, requiring 4 doses of pneumococcal conjugate vaccine (at 2, 4, 6, and 12-15 months), and catch-up vaccination of children aged 2 to 4.9 years requiring 1 dose, with children receiving no intervention.

Main Outcome Measures Cost per life-year saved and cost per episode of meningitis, bacteremia, pneumonia, and otitis media prevented.

Results Vaccination of healthy infants would prevent more than 12,000 cases of meningitis and bacteremia, 53,000 cases of pneumonia, 1 million episodes of otitis media, and 116 deaths due to pneumococcal infection. Before accounting for vaccine costs, the vaccination program would save $342 million in medical and $415 million in work-loss and other costs from averted pneumococcal disease. Vaccination of healthy infants would result in net savings for society if the vaccine cost less than $46 per dose, and net savings for the health care payer if the vaccine cost less than $18 per dose. At the manufacturer's list price of $58 per dose, infant vaccination would cost society $80,000 per life-year saved or $160 per otitis media episode prevented (other estimated costs would be $3200 per pneumonia case prevented, $15,000 for bacteremia, and $280,000 for meningitis). The cost-effectiveness of an additional program to administer 1 dose of vaccine to children aged 2 to 4.9 years would vary depending on the children's ages, relative risks of pneumococcal disease, and vaccine cost.

Conclusions Pneumococcal conjugate vaccination of healthy US infants has the potential to be cost-effective. To achieve cost savings, its cost would need to be lower than the manufacturer's list price. In addition to tangible costs, the vaccine should be appraised based on the less tangible value of preventing mortality and morbidity from pneumococcal disease.

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Figure 1. Policy Options and Clinical Outcomes After No Vaccination or Vaccination of All Healthy Infants With Pneumococcal Conjugate Vaccine
Graphic Jump Location
Dashed lines denote outcomes for which incidence estimates are used; these outcomes are not mutually exclusive. Node 2 is identical in structure to node 1, but disease incidence is reduced due to vaccination.
Figure 2. Projected Cost per Life-Year Saved and Cost per Otitis Media Episode Prevented by Routine Pneumococcal Conjugate Vaccination of Healthy US Infants, at Varying Vaccine Cost per Dose
Graphic Jump Location
Four doses would be recommended for infant vaccination. Cost-effectiveness analysis from the societal perspective includes medical and nonmedical costs; cost-effectiveness analysis from the health care payer perspective includes medical costs primarily borne by health plans.
Figure 3. Two-Way Sensitivity Analysis That Illustrates How the Break-Even Vaccine Cost for Children Aged 2 to 4.9 Years Varies Depending on the Relative Risk of Disease
Graphic Jump Location
The lines represent the break-even vaccine costs at varying relative risks of disease from the societal perspective (medical and nonmedical costs) and health care payer perspective (medical costs). For costs and relative risks below each line, vaccination would result in net savings. Above each line, vaccination would result in net costs. Children in day care have a relative risk of 2.4 compared with those not in day care.

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