title: Vaccination of risk groups in England using the 13 valent pneumococcal conjugate vaccine: economic analysis.
abstract: OBJECTIVE
  To estimate the cost effectiveness of vaccinating people with high risk conditions against invasive pneumococcal disease using the 13 valent pneumococcal conjugate vaccine.
  
  
  METHODS
  Economic evaluation using a cohort model from the perspective of healthcare providers.
  
  
  METHODS
  England.
  
  
  METHODS
  People aged 2 years and older at increased risk of invasive pneumococcal disease due to chronic kidney disease; splenic dysfunction; HIV infection; a compromised immune system; chronic heart, liver, or respiratory disease; or diabetes.
  
  
  METHODS
  Costs, gains in life years and quality adjusted life years (QALYs), and incremental cost effectiveness ratios.
  
  
  RESULTS
  Increasing indirect protection resulting from the vaccination programme of infants using the 13 valent pneumococcal conjugate vaccine means that the burden of disease preventable by targeting high risk groups will diminish in time. Under base case assumptions--that is, no overall impact on non bacteraemic pneumonia in high risk groups and assuming the high risk vaccination programme would be launched two to three years after the infant programme--the incremental cost effectiveness ratio was estimated to be more than £30,000 (€37,216; $48,210) per QALY gained for most risk groups. If, however, the vaccine does not offer protection against non-bacteraemic pneumococcal pneumonia or the vaccine was introduced concomitantly with the infant 13 valent pneumococcal conjugate vaccination programme then vaccinating high risk people would (more) likely be cost effective. Sensitivity analyses showed that the cost effectiveness was particularly sensitive to assumed herd benefits and vaccine efficacy estimates.
  
  
  CONCLUSIONS
  Under base case assumptions it is unlikely that a pneumococcal vaccination programme aimed at risk groups could be considered cost effective. Uncertainty could be substantially reduced by establishing the effectiveness of the 13 valent pneumococcal conjugate vaccine against non-bacteraemic pneumococcal pneumonia, particularly in at risk groups.
authors.affiliation: Unit of PharmacoEpidemiology and PharmacoEconomics, Department of Pharmacy, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, Netherlands. m.h.rozenbaum@rug.nl
authors.forename: Mark H
authors.initials: MH
authors.lastname: Rozenbaum
authors.forename: Albert Jan
authors.initials: AJ
authors.lastname: van Hoek
authors.forename: Douglas
authors.initials: D
authors.lastname: Fleming
authors.forename: Caroline L
authors.initials: CL
authors.lastname: Trotter
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Miller
authors.forename: W John
authors.initials: WJ
authors.lastname: Edmunds
mesh_terms: D000368:Aged; D002675:Child, Preschool; D002908:Chronic Disease / Q000453:epidemiology; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D011008:Pneumococcal Infections / Q000191:economics* / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage* / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D012494:Sampling Studies; D016896:Treatment Outcome; D014611:Vaccination / Q000191:economics*
chemical_list: C538862:13-valent pneumococcal vaccine; D022242:Pneumococcal Vaccines