title: Cost effectiveness of adding 7-valent pneumococcal conjugate (PCV-7) vaccine to the Norwegian childhood vaccination program.
abstract: BACKGROUND
  Streptococcus pneumoniae is a frequent bacterial cause of serious infections that may cause permanent sequelae and death. A 7-valent conjugate vaccine may reduce the incidence of pneumococcal disease, but some previous studies have questioned the cost-effectiveness of the vaccine. The aim of this study was to estimate costs and health consequences of adding this pneumococcal vaccine to the Norwegian childhood vaccination programme, taking the possibility of herd immunity into account.
  
  
  METHODS
  We developed a simulation model (Markov-model) using data on the risk of pneumococcal disease in Norway, the efficacy of the vaccine as observed in clinical trials from other countries and adjusted for serotype differences, the cost of the vaccine and quality of life for patients with sequelae from pneumococcal disease. The results were expressed as incremental (additional) costs (in euros; euro1.00 approximately NOK8.37), incremental life years and incremental quality adjusted life years. Four different sets of main results are presented: costs and (quality adjusted) life years, with and without indirect costs (the value of lost production due to work absenteeism) and with and without potential herd immunity (i.e. childhood vaccination protects adults against pneumococcal disease).
  
  
  RESULTS
  When indirect costs were disregarded, and four vaccine doses used, the incremental cost per life year gained was euro153,000 when herd immunity was included, and euro311,000 when it was not. When accounting for indirect costs as well, the cost per life year gained was euro58,000 and euro124,000, respectively. Assuming that three vaccine doses provide the same protection as four, the cost per life year gained with this regimen was euro90,000 with herd immunity and euro184,000 without (when indirect costs are disregarded). If indirect costs are also included, vaccination both saves costs and gains life years.
  
  
  CONCLUSIONS
  In Norway, governmental guidelines indicate that only interventions with cost per life year of less than euro54,000 should be implemented. This implies that four dose vaccination is not cost-effective even if decision makers includes both herd immunity and indirect costs in their decisions. If three doses offer the same protection as four doses, however, vaccination would be cost-saving when indirect costs are included, but not with only herd immunity.
  
  
  CONCLUSIONS
  In the autumn of 2005, the Norwegian Government decided to include PCV-7 in the vaccination program. This analysis was used by the Ministry of Health and Ministry of Finance during the decision process.
authors.affiliation: Norwegian Knowledge Centre for the Health Services, Department of Pediatrics, Rikshospitalet-Radiumhospitalet Medical Center, University of Oslo, Norway. tow@nokc.no
authors.forename: Torbjørn
authors.initials: T
authors.lastname: Wisløff
authors.forename: Tore G
authors.initials: TG
authors.lastname: Abrahamsen
authors.forename: Marianne A Riise
authors.initials: MA
authors.lastname: Bergsaker
authors.forename: Øistein
authors.initials: Ø
authors.lastname: Løvoll
authors.forename: Per
authors.initials: P
authors.lastname: Møller
authors.forename: Maren Kristine
authors.initials: MK
authors.lastname: Pedersen
authors.forename: Ivar Sønbø
authors.initials: IS
authors.lastname: Kristiansen
mesh_terms: D016470:Bacteremia / Q000191:economics / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D006801:Humans; D032521:Immunity, Herd; D017589:Immunization Programs / Q000191:economics*; D008390:Markov Chains; D008586:Meningitis, Pneumococcal / Q000191:economics / Q000517:prevention & control; D022401:Meningococcal Vaccines / Q000008:administration & dosage / Q000191:economics*; D009664:Norway; D011008:Pneumococcal Infections / Q000191:economics / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage / Q000191:economics*; D014611:Vaccination / Q000191:economics; D018074:Vaccines, Conjugate / Q000008:administration & dosage / Q000191:economics*
chemical_list: D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D022401:Meningococcal Vaccines; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate