Cost effectiveness analysis of heptavalent pneumococcal conjugate vaccine in Germany considering herd immunity effects.
BACKGROUND
In Germany the heptavalent pneumococcal conjugate vaccine (PCV7) has been recommended as a general infant vaccination since 2006. Data from similar programmes in the USA have reported a reduction of pneumococcal diseases in both vaccinated and unvaccinated populations, suggesting herd immunity effects. This study analyses the cost-effectiveness of a general vaccination with PCV7 in Germany based on these findings.


METHODS
A Markov model adapts efficacy and herd immunity data to the German population. Further main model inputs are incidence, vaccination uptake, serotype distribution, case fatality rates, and vaccination and health-care costs.


RESULTS
A general vaccination with PCV7 would avoid about 232,000 pneumococcal infections and 1,879 premature deaths per year in Germany. From the health-care payer's perspective, direct cost savings would outweigh vaccination expenditures by a ratio of 1:1.16. The sensitivity analysis shows that these estimates are quite conservative.


CONCLUSIONS
Based on the health-economic evaluation, the authors recommend the continuation of the general recommendation of PCV7 according to the 3 + 1 schedule within the German Statutory Health Insurance.
Claes
Christa
C
Centre for Health Economics and Health System Research, Leibniz University of Hannover, Hannover, Germany. cc@ivbl.uni-hannover.de
Reinert
Ralf René
RR
von der Schulenburg
Johann-Matthias Graf
JM
D000293:Adolescent; D000328:Adult; D000368:Aged; D029681:Arabidopsis Proteins; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D004268:DNA-Binding Proteins; D005260:Female; D005858:Germany / Q000453:epidemiology; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D006801:Humans; D032521:Immunity, Herd; D017589:Immunization Programs; D015994:Incidence; D007223:Infant; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D022242:Pneumococcal Vaccines / Q000191:economics*; D011018:Pneumonia, Pneumococcal / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control; D055815:Young Adult
D029681:Arabidopsis Proteins; D004268:DNA-Binding Proteins; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D022242:Pneumococcal Vaccines; C480198:QALGGH zinc finger protein, Arabidopsis