Enhanced decision support for policy makers using a web interface to health-economic models—Illustrated with a cost-effectiveness analysis of nation-wide infant vaccination with the 7-valent pneumococcal conjugate vaccine in the Netherlands

Abstract

Enhanced decision support for policy makers using a web interface to health-economic models -Illustrated with a cost-effectiveness analysis of nation-wide infant vaccination with the 7-valent pneumococcal conjugate vaccine in the Netherlands Hubben, G.A.A.; Bos, J.M.; Glynn, D.M.; op 't Ende, Anna; van Alphen, L.; Postma, Maarten Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum. AbstractWe have developed a web-based user-interface (web interface) to enhance the usefulness of health-economic evaluations to support decision making (http://pcv.healtheconomics.nl). It allows the user to interact with a health-economic model to evaluate predefined and customized scenarios and perform sensitivity analysis. To explore its usefulness, it was applied to an evaluation of cost-effectiveness of nation-wide infant vaccination with the 7-valent pneumococcal conjugate vaccine (PCV7), that was used to support a policy decision on the inclusion of PCV7 in the national vaccination program (NVP) of the Netherlands. We used a decision-tree analytic model to project the impact of infant vaccination with four doses of PCV7 on an annual cohort of infants born in the Netherlands. The base-case analysis includes the beneficial effects on unvaccinated individuals (herd protection). Additional scenarios varying the number of doses, discount rate for effects and the number of serotypes in the vaccine were evaluated and can be analysed on the web. Our model projects a base-case incremental cost-effectiveness ratio (iCER) of D 14,000 (95% uncertainty interval (UI): 9,800-20,200) per quality adjusted life year (QALY) or D 15,600 (95% UI: 11,100-23,900) per life year gained (LYG).

Economic Evaluation of Childhood 7-Valent Pneumococcal Conjugate Vaccination in Korea

“…However, after adjustment for the incidence rates of meningitis and bacteremia and inclusion of the herd protection effect (i.e., reduction in the disease incidence rate from reduced transmission of pneumococci after infant vaccination to nonvaccinated individuals), 62 the ICER was reduced by one-fourth. 58,63 In these studies, vaccine purchasing cost was found to be the most important variable that affects the decision whether to include PCV-7 in the national immunization program in individual countries.…”

Public health economics of vaccines in the Netherlands: methodological issues and applications

“…Recently, new data have been analysed, and updated estimates of cost-effectiveness have been provided. A striking decrease in the cost-effectiveness ratio as compared to the 2001 estimate has been published again in Vaccine (Hubben et al 2007). In particular, base-case cost-effectiveness was estimated at €15,600 per life-year gained.…”

“…In particular, (1) oneoff vaccination at 14 months, (2) two doses at 5 and 6 months, and (3) three doses very early in infancy (2, 3 and 4 months) were all assumed to provide similar longterm protection (in the model assumed at 90% effectiveness for a duration of 20 years, as seen for other conjugate vaccines). In an aggregate analysis-each scenario in turn being compared with "doing-nothing"-all scenarios provided acceptable cost-effectiveness ratios per life-year gained (Table 2) if we recall that for the Netherlands once a threshold has been suggested at €20,000 per life-year gained (Hubben et al 2007). This might be labelled "the aggregate approach", also sometimes referred to as calculating average cost-effectiveness.…”

“…It can be seen that the majority of life-years gained are derived from averted deaths in the 19,900 2.2** 146,900** *As compared to "do nothing"; **as compared to "14 months"; NA=not applicable Source: Welte et al 2004 elderly through indirect protection. With the 2001 estimate not yet including the herd-immunity effects, the difference between both estimates for cost-effectiveness of pneumococcal vaccination is readily explained (Hubben et al 2007). Finally, Fig.…”

Cost–effectiveness models of pneumococcal conjugate vaccines: variability and impact of modeling assumptions

“…As data showing disease reduction in unvaccinated cohorts began to emerge, the earlier models were revised to include herd effects. This led to PCV7 becoming cost effective and eventually to cost-savings in markets where PCV7 penetration was high over a longer duration and led to a substantial herd effect [19,[34][35][36][37][38].…”