title: Cost-effectiveness of heptavalent conjugate pneumococcal vaccine (Prevenar) in Germany: considering a high-risk population and herd immunity effects.
abstract: In Germany, the seven-valent conjugate vaccine Prevenar is recommended for use in children at high risk of pneumococcal disease. Recent data suggest that giving conjugate vaccine to all children may lead to a decline in pneumococcal disease in unvaccinated adults, a phenomenon known as herd immunity. This analysis evaluated the cost and economic consequences in Germany of vaccinating (1) children at high risk, (2) all children when considering only benefits for vaccinated individuals and (3) all children when also considering herd immunity benefits. Costs in the model included vaccination, management of meningitis, bacteraemia, pneumonia and acute otitis media, insurance payments to parents and the costs of care for long-term disabilities. The model estimated that the cost-effectiveness of vaccination would be 38,222 euros per life year gained in children at high risk and 100,636 euros per life year gained in all children when not considering herd immunity. When considering herd immunity effects, the model estimated that offering vaccination for all children would reduce adult deaths by 3,027 per year, and vaccination would be broadly cost neutral. The findings are sensitive to the effect of conjugate vaccine on the rates of pneumonia and invasive disease in the elderly. If the herd immunity effect of conjugate vaccination in Germany is similar to that observed elsewhere, offering vaccine to all children will be more attractive than the current policy of restricting vaccination to children at high risk of pneumococcal disease.
authors.affiliation: Fourth Hurdle Consulting Ltd, London, WC1V 6PL, UK. adamlloyd@fourthhurdle.com
authors.forename: Adam
authors.initials: A
authors.lastname: Lloyd
authors.forename: Nishma
authors.initials: N
authors.lastname: Patel
authors.forename: David A
authors.initials: DA
authors.lastname: Scott
authors.forename: Claus
authors.initials: C
authors.lastname: Runge
authors.forename: Christa
authors.initials: C
authors.lastname: Claes
authors.forename: Markus
authors.initials: M
authors.lastname: Rose
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005858:Germany / Q000453:epidemiology; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D006801:Humans; D032521:Immunity, Herd / Q000276:immunology*; D017589:Immunization Programs / Q000191:economics / Q000706:statistics & numerical data; D007223:Infant; D022401:Meningococcal Vaccines / Q000008:administration & dosage / Q000191:economics* / Q000276:immunology / Q000627:therapeutic use; D008875:Middle Aged; D018803:Models, Economic; D011008:Pneumococcal Infections / Q000188:drug therapy / Q000276:immunology / Q000401:mortality / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000008:administration & dosage / Q000191:economics* / Q000276:immunology / Q000627:therapeutic use; D018570:Risk Assessment
chemical_list: D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D022401:Meningococcal Vaccines; D022242:Pneumococcal Vaccines