[Cost-effectiveness of 23-valent antipneumococcical vaccination in Catalonia (Spain)].
OBJECTIVE
Pneumococcal vaccination is an effective procedure for preventing pneumococcal pneumonia. In this study we evaluate the cost-effectiveness of pneumococcal vaccination strategies (23 serotypes) in the population aged 5 years and older in Catalonia.


METHODS
Cost-effectiveness was evaluated in terms of cost per year of life gained (YLG) by comparing the net cost of the vaccination program with its effectiveness. The net cost of the vaccination program was calculated by subtracting 70% of the population from the vaccination costs, representing the reduction in health costs due to pneumococcal pneumonia that can ve achieved with vaccination. Vaccination costs were estimated based on a price of 12.41 euros (1,915 ptas.) for pneumococcal vaccine. The costs and benefits of the vaccination program were updated for 1996 by using a discount rate of 5%.


RESULTS
A cost-effectiveness ratio of 9,023.27 euros per YLG was achieved for universal vaccination of the population. Cost-effectiveness was 11,3177.12 euros per YLG in individuals aged 5-24 years, 19,482.51 euros per TLG in those aged 25-44 years, 7,122.80 euros per YLG in those aged 45-64 years and less than 0 in those aged 65 years and older. In this group the reduction in cost of the disease was greater than the vaccination costs with a cost-benefit ratio of 1.58. The results of the cost-efecctiveness analysis were sensitive to vaccine costs and efficacy and the percentage of pneumonias caused by pneumococcus but were less sensitive to the costs of pneumococcal pneumonia, the rate of hospital admission among patients with community-acquired pneumonia and vaccine coverage.


CONCLUSIONS
The results of this study show that pneumococcal vaccination should be a priority in individuals aged 65 years and older and in those aged 45-64 years.
Plans
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Servei d'Avaluació de Programes. Direcció General de Salut Pública. Departament de Sanitat. Barcelona. España.
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D006801:Humans; D008875:Middle Aged; D022242:Pneumococcal Vaccines / Q000191:economics*; D011018:Pneumonia, Pneumococcal / Q000191:economics* / Q000517:prevention & control* / Q000628:therapy; D011135:Polysaccharides, Bacterial / Q000191:economics*; D013030:Spain
C414006:23-valent pneumococcal capsular polysaccharide vaccine; D022242:Pneumococcal Vaccines; D011135:Polysaccharides, Bacterial