Preferences for health outcomes associated with Group A Streptococcal disease and vaccination

Health and Quality of Life Outcomes

Research

James K Hammitt¹  Joshua A Salomon²  Charlene Gay³  Grace M Lee⁴ 

[1] Center for Risk Analysis and Department of Health Policy and Management, Harvard School of Public Health, 718 Huntington Avenue, 02115, Boston, MA, USA;Department of Global Health and Population, Harvard School of Public Health, 665 Huntington Avenue, 02115, Boston, MA, USA;Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 02215, Boston, MA, USA;Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 02215, Boston, MA, USA;Division of Infectious Diseases, Department of Medicine, and Department of Laboratory Medicine, Children’s Hospital Boston, 300 Longwood Avenue, 02115, Boston, MA, USA;

关键词: Septic Arthritis;    Local Reaction;    Necrotizing Fasciitis;    Toxic Shock Syndrome;    Impetigo;   

DOI  :  10.1186/1477-7525-8-28

 received in 2009-08-17, accepted in 2010-03-12,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundA 26-valent Group A Streptococcus (GAS) vaccine candidate has been developed that may provide protection against pharyngitis, invasive disease and rheumatic fever. However, recommendations for the use of a new vaccine must be informed by a range of considerations, including parents' preferences for different relevant health outcomes. Our objectives were to: (1) describe parent preferences for GAS disease and vaccination using willingness-to-pay (WTP) and time trade-off (TTO) methods; and (2) understand how parents' implied WTP for a quality-adjusted life year (QALY) gained might vary depending on the particular health outcome considered (e.g. averted GAS disease vs. vaccine adverse events).MethodsTelephone interviews were conducted with parents of children diagnosed with GAS pharyngitis at 2 pediatric practice sites in the Boston metropolitan area. WTP and TTO (trading parental longevity for child's health) questions for 2 vaccine and 4 disease-associated health states were asked using a randomly selected opening bid, followed by a 2nd bid and a final open-ended question about the amount willing to pay or trade. Descriptive analyses included medians and interquartile ranges for WTP and TTO estimates. The Wilcoxon signed-rank test was used to assess differences in WTP/QALY values for vaccine adverse events vs. disease states.ResultsOf 119 respondents, 100 (84%) and 96 (81%) provided a complete set of responses for WTP and TTO questions, respectively. The median WTP and discounted (at 3% per year) TTO values to avoid each health state were as follows: local reaction, $30, 0.12 days; systemic reaction, $50, 0.22 days; impetigo, $75, 1.25 days; strep throat, $75, 2.5 days; septic arthritis, $1,000, 6.6 days; and toxic shock syndrome, $3,000, 31.0 days. The median WTP/QALY was significantly higher for vaccine adverse events (~$60,000/QALY) compared to disease states ($18,000 to $36,000/QALY).ConclusionsParents strongly prefer to prevent GAS disease in children compared to vaccine adverse events. However, implied WTP/QALY ratios were higher for the prevention of vaccine adverse events. Regret for errors of commission vs. omission may differ and should be considered by vaccine policymakers.

【 授权许可】

CC BY   
© Lee et al; licensee BioMed Central Ltd. 2010