title: Helicobacter pylori vaccine development and use: a cost-effectiveness analysis using the Institute of Medicine Methodology.
abstract: BACKGROUND
  Prophylactic vaccination has been suggested as a better strategy than antibiotics to control Helicobacter pylori infection. We evaluated the cost-effectiveness (CE) of H. pylori vaccine development and use in the United States and developing countries, using a method developed by the Institute of Medicine (IOM).
  
  
  METHODS
  The IOM model includes costs of vaccine development, vaccination program, and averted medical treatments; morbidity and mortality prevented; expected efficacy and use; and proportion of disease that is vaccine-preventable. The model employs infant mortality equivalence (IME) to estimate disease burden; with IME, the societal cost of infection-related morbidity is expressed as equivalent to a specific rate of infant deaths. We tested model assumptions by univariate sensitivity analyses.
  
  
  RESULTS
  In the United States, H. pylori vaccine would save 1,176 IME and would cost $58.71 million (1997 dollars) annually, yielding a CE ratio of $49,932 per IME; the health benefits would exceed all IOM-studied vaccines, even when efficacy dropped to 55%. H. pylori vaccine could be cost-saving if priced at less than $60 per course. In developing countries, H. pylori vaccine would rank unfavorably both in terms of health benefits (33,518 IME) and costs ($5,254 million). None of the changes in assumptions improved significantly the H. pylori vaccine's ranking relative to other IOM-studied vaccines.
  
  
  CONCLUSIONS
  Compared to other vaccines evaluated in the IOM study, H. pylori vaccine warrants public resource allocation for accelerated development and use in the United States but not for use in developing countries.
authors.affiliation: Department of Engineering-Economic Systems and Operations Research, Stanford University, CA, USA. marcia.rupnow@stanfordalumni.org
authors.forename: M F
authors.initials: MF
authors.lastname: Rupnow
authors.forename: D K
authors.initials: DK
authors.lastname: Owens
authors.forename: R
authors.initials: R
authors.lastname: Shachter
authors.forename: J
authors.initials: J
authors.lastname: Parsonnet
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001428:Bacterial Vaccines / Q000008:administration & dosage / Q000191:economics* / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003906:Developing Countries; D016481:Helicobacter Infections / Q000517:prevention & control*; D016480:Helicobacter pylori / Q000276:immunology*; D006801:Humans; D017589:Immunization Programs / Q000191:economics; D007223:Infant; D008875:Middle Aged; D015969:National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division; D010437:Peptic Ulcer / Q000517:prevention & control*; D013274:Stomach Neoplasms / Q000150:complications / Q000517:prevention & control; D014481:United States; D014611:Vaccination
chemical_list: D001428:Bacterial Vaccines