Cost-effectiveness of a potential prophylactic Helicobacter pylori vaccine in the United States.
BACKGROUND
Helicobacter pylori vaccines are under development to prevent infection. We quantified the cost-effectiveness of such a vaccine in the United States, using a dynamic transmission model.


METHODS
We compartmentalized the population by age, infection status, and clinical disease state and measured effectiveness in quality-adjusted life years (QALYs). We simulated no intervention, vaccination of infants, and vaccination of school-age children. Variables included costs of vaccine, vaccine administration, and gastric cancer treatment (in 2007 US dollars), vaccine efficacy, quality adjustment due to gastric cancer, and discount rate. We evaluated possible outcomes for periods of 10-75 years.


RESULTS
H. pylori vaccination of infants would cost $2.9 billion over 10 years; savings from cancer prevention would be realized decades later. Over a long time horizon (75 years), incremental costs of H. pylori vaccination would be $1.8 billion, and incremental QALYs would be 0.5 million, yielding a cost-effectiveness ratio of $3871/QALY. With school-age vaccination, the cost-effectiveness ratio would be $22,137/QALY. With time limited to <40 years, the cost-effectiveness ratio exceeded $50,000/QALY.


CONCLUSIONS
When evaluated with a time horizon beyond 40 years, the use of a prophylactic H. pylori vaccine was cost-effective in the United States, especially with infant vaccination.
Rupnow
Marcia F T
MF
Department of Management Science and Engineering, Stanford University, Stanford, California, USA.
Chang
Alicia H
AH
Shachter
Ross D
RD
Owens
Douglas K
DK
Parsonnet
Julie
J
D001428:Bacterial Vaccines / Q000191:economics* / Q000276:immunology*; D002648:Child; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D016481:Helicobacter Infections / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D016480:Helicobacter pylori / Q000276:immunology*; D006801:Humans; D007223:Infant; D008954:Models, Biological; D011788:Quality of Life; D014481:United States / Q000453:epidemiology
D001428:Bacterial Vaccines