title: Retrospective economic evaluation of childhood 7-valent pneumococcal conjugate vaccination in Australia: Uncertain herd impact on pneumonia critical.
abstract: BACKGROUND
  Retrospective cost-effectiveness analyses of vaccination programs using routinely collected post-implementation data are sparse by comparison with pre-program analyses. We performed a retrospective economic evaluation of the childhood 7-valent pneumococcal conjugate vaccine (PCV7) program in Australia.
  
  
  METHODS
  We developed a deterministic multi-compartment model that describes health states related to invasive and non-invasive pneumococcal disease. Costs (Australian dollars, A$) and health effects (quality-adjusted life years, QALYs) were attached to model states. The perspective for costs was that of the healthcare system and government. Where possible, we used observed changes in the disease rates from national surveillance and healthcare databases to estimate the impact of the PCV7 program (2005-2010). We stratified our cost-effectiveness results into alternative scenarios which differed by the outcome states included. Parameter uncertainty was explored using probabilistic sensitivity analysis.
  
  
  RESULTS
  The PCV7 program was estimated to have prevented ∼5900 hospitalisations and ∼160 deaths from invasive pneumococcal disease (IPD). Approximately half of these were prevented in adults via herd protection. The incremental cost-effectiveness ratio was ∼A$161,000 per QALY gained when including only IPD-related outcomes. The cost-effectiveness of PCV7 remained in the range A$88,000-$122,000 when changes in various non-invasive disease states were included. The inclusion of observed changes in adult non-invasive pneumonia deaths substantially improved cost-effectiveness (∼A$9000 per QALY gained).
  
  
  CONCLUSIONS
  Using the initial vaccine price negotiated for Australia, the PCV7 program was unlikely to have been cost-effective (at conventional thresholds) unless observed reductions in non-invasive pneumonia deaths in the elderly are attributed to it. Further analyses are required to explore this finding, which has significant implications for the incremental benefit achievable by adult PCV programs.
authors.affiliation: School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, Australia. Electronic address: a.newall@unsw.edu.au.
authors.forename: A T
authors.initials: AT
authors.lastname: Newall
authors.affiliation: School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, Australia.
authors.forename: J F
authors.initials: JF
authors.lastname: Reyes
authors.affiliation: National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), University of Sydney, Westmead, NSW, Australia.
authors.forename: P
authors.initials: P
authors.lastname: McIntyre
authors.affiliation: National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), University of Sydney, Westmead, NSW, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Menzies
authors.affiliation: School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, Australia; Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Beutels
authors.affiliation: School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, Australia.
authors.forename: J G
authors.initials: JG
authors.lastname: Wood
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D000069443:Heptavalent Pneumococcal Conjugate Vaccine / Q000008:administration & dosage / Q000191:economics* / Q000276:immunology*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011018:Pneumonia, Pneumococcal / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies; D014611:Vaccination / Q000191:economics*; D055815:Young Adult
chemical_list: D000069443:Heptavalent Pneumococcal Conjugate Vaccine
keywords: Cost-effectiveness; PCV7; Pneumococcal vaccination; Post-implementation; Program evaluation; Retrospective