Potential Cost-Effectiveness of RSV Vaccination of Infants and Pregnant Women in Turkey: An Illustration Based on Bursa Data.
BACKGROUND
Worldwide, respiratory syncytial virus (RSV) is considered to be the most important viral cause of respiratory morbidity and mortality among infants and young children. Although no active vaccine is available on the market yet, there are several active vaccine development programs in various stages. To assess whether one of these vaccines might be a future asset for national immunization programs, modeling the costs and benefits of various vaccination strategies is needed.


OBJECTIVE
To evaluate the potential cost-effectiveness of RSV vaccination of infants and/or pregnant women in Turkey.


METHODS
A multi-cohort static Markov model with cycles of one month was used to compare the cost-effectiveness of vaccinated cohorts versus non-vaccinated cohorts. The 2014 Turkish birth cohort was divided by twelve to construct twelve monthly birth cohorts of equal size (111,459 new-borns). Model input was based on clinical data from a multicenter prospective study from Bursa, Turkey, combined with figures from the (inter)national literature and publicly available data from the Turkish Statistical Institute (TÜÏK). Incremental cost-effectiveness ratios (ICERs) were expressed in Turkish Lira (TL) per quality-adjusted life year (QALY) gained.


RESULTS
Vaccinating infants at 2 and 4 months of age would prevent 145,802 GP visits, 8,201 hospitalizations and 48 deaths during the first year of life, corresponding to a total gain of 1650 QALYs. The discounted ICER was estimated at 51,969 TL (26,220 US $ in 2013) per QALY gained. Vaccinating both pregnant women and infants would prevent more cases, but was less attractive from a pure economic point of view with a discounted ICER of 61,653 TL (31,106 US $ in 2013) per QALY. Vaccinating only during pregnancy would result in fewer cases prevented than infant vaccination and a less favorable ICER.


CONCLUSIONS
RSV vaccination of infants and/or pregnant women has the potential to be cost-effective in Turkey. Although using relatively conservative assumptions, all evaluated strategies remained slightly below the threshold of 3 times the GDP per capita.
Unit of PharmacoEpidemiology & PharmacoEconomics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands.|Modelling & Economics Unit, Centre for Infectious Disease Surveillance & Control, Public Health England, London, United Kingdom.
Koen B
KB
Pouwels
Division of Pediatric Infectious Diseases, Uludağ University Faculty of Medicine, Bursa, Turkey.
Sefika E
SE
Bozdemir
Department of Pharmacy Management, Hacettepe University Faculty of Pharmacy, Ankara, Turkey.
Selen
S
Yegenoglu
Division of Pediatric Infectious Diseases, Uludağ University Faculty of Medicine, Bursa, Turkey.
Solmaz
S
Celebi
Department of Medicine, Imperial College London, London, United Kingdom.
E David
ED
McIntosh
Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Serhat
S
Unal
Unit of PharmacoEpidemiology & PharmacoEconomics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands.|Institute of Science in Healthy Aging & healthcaRE (SHARE), University Medical Center Groningen (UMCG), Groningen, The Netherlands.|Department of Epidemiology, UMCG, University of Groningen, Groningen, The Netherlands.
Maarten J
MJ
Postma
Division of Pediatric Infectious Diseases, Uludağ University Faculty of Medicine, Bursa, Turkey.
Mustafa
M
Hacimustafaoglu
Influenza Other Respir Viruses. 2014 Sep;8(5):507-15
24975705
Epidemiol Infect. 2006 Jun;134(3):506-13
16638164
Pharmacoeconomics. 2007;25(1):55-71
17192118
Vaccine. 2013 Apr 18;31 Suppl 2:B209-15
23598484
Heart. 2001 Apr;85(4):438-43
11250973
N Engl J Med. 2001 Jun 21;344(25):1917-28
11419430
Vaccine. 2013 Sep 13;31(40):4347-54
23896421
Vaccine. 2012 Jun 29;30(31):4691-700
22561315
Pediatr Infect Dis J. 1999 Feb;18(2):173
10048697
Clin Vaccine Immunol. 2015 Dec 16;23 (3):189-95
26677198
Vaccine. 2013 Dec 16;31(52):6254-60
24148573
Epidemiol Infect. 2010 Jun;138(6):853-60
20003640
Vaccine. 2000 Feb 14;18(15):1485-94
10618546
PLoS One. 2015 Sep 21;10(9):e0138018
26390032
Pediatrics. 2015 Jan;135(1):e24-31
25489019
Pediatr Infect Dis J. 2006 Mar;25(3):201-7
16511380
Pediatr Infect Dis J. 2014 Aug;33(8):829-34
25222302
BMC Med. 2015 Mar 10;13:49
25857701
Arch Dis Child. 2004 Jul;89(7):673-8
15210503
Vaccine. 2010 Dec 10;29(1):115-22
21055501
Emerg Infect Dis. 2015 Nov;21(11):1951-5
26485575
Vaccine. 2013 Jan 30;31(6):979-86
23219433
Arch Dis Child. 2004 Jan;89(1):52-3
14709507
Pediatr Infect Dis J. 2013 Aug;32(8):820-6
23518824
Epidemiol Infect. 2008 Aug;136(8):1046-58
17903316
BMC Health Serv Res. 2012 Nov 09;12 :386
23137037
Pediatrics. 2013 Aug;132(2):e341-8
23878043
Expert Rev Vaccines. 2016;15(2):149-52
26636902
Vaccine. 2009 Feb 11;27(7):1119-26
19071185
N Engl J Med. 2009 Feb 5;360(6):588-98
19196675
Curr Opin Pharmacol. 2014 Jun;16:82-8
24810284
Turk J Pediatr. 2013 Mar-Apr;55(2):130-9
24192672
N Engl J Med. 1979 Mar 8;300(10):530-4
763253
PLoS Med. 2013 Oct;10(10):e1001527
24115913
Curr Med Res Opin. 2010 Sep;26(9):2175-81
20666690
JAMA. 2003 Jan 8;289(2):179-86
12517228
Clin Infect Dis. 2014 May;58(9):1241-9
24567249
Turk J Pediatr. 2012 May-Jun;54(3):216-22
23094529
Pediatr Infect Dis J. 2001 Jun;20(6):574-81
11419498
Lancet. 2010 May 1;375(9725):1545-55
20399493
Health Econ Rev. 2013 Aug 06;3(1):18
23919494
N Engl J Med. 2013 May 9;368(19):1791-9
23656644