title: The potential economic value of a Staphylococcus aureus vaccine among hemodialysis patients.
abstract: Staphylococcus aureus infections are a substantial problem for hemodialysis patients. Several vaccine candidates are currently under development, with hemodialysis patients being one possible target population. To determine the potential economic value of an S. aureus vaccine among hemodialysis patients, we developed a Markov decision analytic computer simulation model. When S. aureus colonization prevalence was 1%, the incremental cost-effectiveness ratio (ICER) of vaccination was ≤$25,217/quality-adjusted life year (QALY). Vaccination became more cost-effective as colonization prevalence, vaccine efficacy, or vaccine protection duration increased or vaccine cost decreased. Even at 10% colonization prevalence, a 25% efficacious vaccine costing $100 prevented 29 infections, 21 infection-related hospitalizations, and 9 inpatient deaths per 1000 vaccinated HD patients. Our results suggest that an S. aureus vaccine would be cost-effective (i.e., ICERs ≤ $50,000/QALY) among hemodialysis patients over a wide range of S. aureus prevalence, vaccine costs and efficacies, and vaccine protection durations and delineate potential target parameters for such a vaccine.
authors.affiliation: Public Health Computational and Operations Research (PHICOR), University of Pittsburgh, 3520 Forbes Avenue, Pittsburgh, PA 15213, USA. ysongmd@umich.edu
authors.forename: Yeohan
authors.initials: Y
authors.lastname: Song
authors.forename: Julie H Y
authors.initials: JH
authors.lastname: Tai
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Bartsch
authors.forename: Richard K
authors.initials: RK
authors.lastname: Zimmerman
authors.forename: Robert R
authors.initials: RR
authors.lastname: Muder
authors.forename: Bruce Y
authors.initials: BY
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D006435:Renal Dialysis / Q000009:adverse effects*; D013203:Staphylococcal Infections / Q000191:economics / Q000517:prevention & control*; D013209:Staphylococcal Vaccines / Q000008:administration & dosage* / Q000191:economics / Q000276:immunology*; D013211:Staphylococcus aureus / Q000276:immunology*
chemical_list: D013209:Staphylococcal Vaccines