Cost effectiveness of pediatric pneumococcal conjugate vaccines: a comparative assessment of decision-making tools

BMC Medicine

Research Article

Ratchadaporn Somkrua¹  Nathorn Chaiyakunapruk²  Philippe Beutels³  Alessia Melegaro⁴  Joachim Hombach⁵  Ana Maria Henao⁵  Raymond Hutubessy⁵  John W Edmunds⁶ 

[1] Center of Pharmaceutical Outcomes Research, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand;Center of Pharmaceutical Outcomes Research, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand;School of Population Health, University of Queensland, Brisbane, Australia;School of Pharmacy, University of Wisconsin, Madison, Wisconsin, USA;Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute, University of Antwerp, Belgium;DONDENA Centre for Research on Social Dynamics, Bocconi University, Milan, Italy;Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland;London School of Hygiene and Tropical Medicine, London, UK;

关键词: Incremental Cost;    Acute Otitis Medium;    Pneumococcal Pneumonia;    Pneumococcal Conjugate Vaccine;    Herd Effect;   

DOI  :  10.1186/1741-7015-9-53

 received in 2010-11-29, accepted in 2011-05-12,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundSeveral decision support tools have been developed to aid policymaking regarding the adoption of pneumococcal conjugate vaccine (PCV) into national pediatric immunization programs. The lack of critical appraisal of these tools makes it difficult for decision makers to understand and choose between them. With the aim to guide policymakers on their optimal use, we compared publicly available decision-making tools in relation to their methods, influential parameters and results.MethodsThe World Health Organization (WHO) requested access to several publicly available cost-effectiveness (CE) tools for PCV from both public and private provenance. All tools were critically assessed according to the WHO's guide for economic evaluations of immunization programs. Key attributes and characteristics were compared and a series of sensitivity analyses was performed to determine the main drivers of the results. The results were compared based on a standardized set of input parameters and assumptions.ResultsThree cost-effectiveness modeling tools were provided, including two cohort-based (Pan-American Health Organization (PAHO) ProVac Initiative TriVac, and PneumoADIP) and one population-based model (GlaxoSmithKline's SUPREMES). They all compared the introduction of PCV into national pediatric immunization program with no PCV use. The models were different in terms of model attributes, structure, and data requirement, but captured a similar range of diseases. Herd effects were estimated using different approaches in each model. The main driving parameters were vaccine efficacy against pneumococcal pneumonia, vaccine price, vaccine coverage, serotype coverage and disease burden. With a standardized set of input parameters developed for cohort modeling, TriVac and PneumoADIP produced similar incremental costs and health outcomes, and incremental cost-effectiveness ratios.ConclusionsVaccine cost (dose price and number of doses), vaccine efficacy and epidemiology of critical endpoint (for example, incidence of pneumonia, distribution of serotypes causing pneumonia) were influential parameters in the models we compared. Understanding the differences and similarities of such CE tools through regular comparisons could render decision-making processes in different countries more efficient, as well as providing guiding information for further clinical and epidemiological research. A tool comparison exercise using standardized data sets can help model developers to be more transparent about their model structure and assumptions and provide analysts and decision makers with a more in-depth view behind the disease dynamics. Adherence to the WHO guide of economic evaluations of immunization programs may also facilitate this process.Please see related article: http://www.biomedcentral.com/1741-7007/9/55

【 授权许可】

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