Cost-effectiveness analysis of changing from live oral poliovirus vaccine to inactivated poliovirus vaccine in Australia.
OBJECTIVE
Estimate the economic impact of introducing inactivated poliovirus vaccine (IPV) into the Australian childhood immunisation schedule to eliminate vaccine-associated paralytic poliomyelitis (VAPP).


METHODS
Cost-effectiveness of two different four-dose IPV schedules (monovalent vaccine and IPV-containing combination vaccine) compared with the current four-dose oral poliovirus vaccine (OPV) schedule for Australian children through age six years. Model used estimates of VAPP incidence, costs, and vaccine utilisation and price obtained from published and unpublished sources. Main outcome measures were total costs, outcomes prevented, and incremental cost-effectiveness, expressed as net cost per case of VAPP prevented.


RESULTS
Changing to an IPV-based schedule would prevent 0.395 VAPP cases annually. At $20 per dose for monovalent vaccine and $14 per dose for the IPV component in a combination vaccine, the change would incur incremental, annual costs of $19.5 million ($49.3 million per VAPP case prevented) and $6.7 million ($17.0 million per VAPP case prevented), respectively. Threshold analysis identified break-even prices per dose of $1 for monovalent and $7 for combination vaccines.


CONCLUSIONS
Introducing IPV into the Australian childhood immunisation schedule is not likely to be cost-effective unless it comes in a combined vaccine with the IPV-component price below $10.


CONCLUSIONS
More precise estimates of VAPP incidence in Australia and IPV price are needed. However, poor cost-effectiveness will make the decision about switching from OPV to IPV in the childhood schedule difficult.
Tucker
A W
AW
National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead, New South Wales.
Isaacs
D
D
Burgess
M
M
D001315:Australia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006801:Humans; D017589:Immunization Programs / Q000191:economics*; D015994:Incidence; D007223:Infant; D017059:Models, Econometric; D015999:Multivariate Analysis; D011050:Policy Making; D011051:Poliomyelitis / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D011054:Poliovirus Vaccine, Inactivated / Q000008:administration & dosage / Q000191:economics*; D011055:Poliovirus Vaccine, Oral / Q000008:administration & dosage / Q000009:adverse effects; D012307:Risk Factors; D012680:Sensitivity and Specificity
D011054:Poliovirus Vaccine, Inactivated; D011055:Poliovirus Vaccine, Oral