Incorporating Herd Immunity Effects into Cohort Models of Vaccine Cost-Effectiveness

Bauch, Chris T.; Anonychuk, Andrea; Effelterre, Thierry Van; Pham, Ba’; Merid, Maraki Fikre

doi:10.1177/0272989x09334419

Cited by 28 publications

(45 citation statements)

References 24 publications

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“…ISPOR-SMDM Modeling Good Research Practices recommend the use of dynamic transmission models to estimate indirect effects where vaccination may effect transmission of the disease[12]. In the model, indirect effects for vaccinated and unvaccinated persons are estimated using an adaptation of a mathematical approximation of dynamic transmission modeling for use in cohort models [13, 14]. With this approach, the infection rate in each year of the projection for all age-groups ( i = 1 to N ) is multiplied by a scaling factor ( s ) that is calculated as follows: …”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of alternate strategies for childhood immunization against meningococcal disease with monovalent and quadrivalent conjugate vaccines in Canada

et al. 2017

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BackgroundPublic health programs to prevent invasive meningococcal disease (IMD) with monovalent serogroup C meningococcal conjugate vaccine (MCV-C) and quadrivalent meningococcal conjugate vaccines (MCV-4) in infancy and adolescence vary across Canadian provinces. This study evaluated the cost-effectiveness of various vaccination strategies against IMD using current and anticipated future pricing and recent epidemiology.MethodsA cohort model was developed to estimate the clinical burden and costs (CAN$2014) of IMD in the Canadian population over a 100-year time horizon for three strategies: (1) MCV-C in infants and adolescents (MCV-C/C); (2) MCV-C in infants and MCV-4 in adolescents (MCV-C/4); and (3) MCV-4 in infants (2 doses) and adolescents (MCV-4/4). The source for IMD incidence was Canadian surveillance data. The effectiveness of MCV-C was based on published literature. The effectiveness of MCV-4 against all vaccination regimens was assumed to be the same as for MCV-C regimens against serogroup C. Herd effects were estimated by calibration to estimates reported in prior analyses. Costs were from published sources. Vaccines prices were projected to decline over time reflecting historical procurement trends.ResultsOver the modeling horizon there are a projected 11,438 IMD cases and 1,195 IMD deaths with MCV-C/C; expected total costs are $597.5 million. MCV-C/4 is projected to reduce cases of IMD by 1,826 (16%) and IMD deaths by 161 (13%). Vaccination costs are increased by $32 million but direct and indirect IMD costs are projected to be reduced by $46 million. MCV-C/4 is therefore dominant vs. MCV-C/C in the base case. Cost-effectiveness of MCV-4/4 was $111,286 per QALY gained versus MCV-C/4 (2575/206 IMD cases/deaths prevented; incremental costs $68 million).ConclusionsIf historical trends in Canadian vaccines prices continue, use of MCV-4 instead of MCV-C in adolescents may be cost-effective. From an economic perspective, switching to MCV-4 as the adolescent booster should be considered.

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Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of alternate strategies for childhood immunization against meningococcal disease with monovalent and quadrivalent conjugate vaccines in Canada

et al. 2017

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“…For example, one method of approximating herd immunity has been proposed that retains a cohort structure but takes into account a gradual reduction in the force of infection until a post-vaccination equilibrium is reached. [55] Figure 3 is a flow diagram with an algorithm with key questions that need to be asked when Q2. Is the disease directly transmitted between humans, and does the intervention affect its potential for transmission?…”

Section: Approximating Herd Immunity In Static Modelsmentioning

confidence: 99%

Modelling the Epidemiology of Infectious Diseases for Decision Analysis

2011

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The number of economic evaluations related to infectious disease topics has increased over the last 2 decades. However, many such evaluations rely on models that do not take into account unique features of infectious diseases that can affect the estimated value of interventions against them. These include their transmissibility from infected to susceptible individuals, the possibility of acquiring natural immunity following recovery from infection and the uncertainties that arise as a result of their complex natural history and epidemiology. Modellers conducting economic evaluations of infectious disease interventions need to know the main features of different types of infectious disease models, the situations in which they should be applied and the effects of model choices on the cost effectiveness of interventions.

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“…The type of model used in vaccine cost-effectiveness analyses can also affect results; for example, whether the main features of the model change over time (dynamic model) or not (static model). [50][51][52][53][54] The effects of herd immunity, whereby vaccination of part of a population confers partial indirect protection for the remainder, [50,52,54] are not captured in static models (e.g. decision-tree, Markov), which results in an underestimation of the cost effectiveness of a vaccination program.…”

Section: Pharmacoeconomic Analyses Of Monovalent Rotavirus Vaccine Rimentioning

confidence: 99%

“…decision-tree, Markov), which results in an underestimation of the cost effectiveness of a vaccination program. [52,54] Two analyses of rotavirus vaccine RIX4414 included the effects of herd immunity, using data from dynamic transmission models in the sensitivity analyses, and in both cases the inclusion of herd immunity effects markedly improved ICER values. [35,43] …”

Section: Pharmacoeconomic Analyses Of Monovalent Rotavirus Vaccine Rimentioning

confidence: 99%

Pharmacoeconomic Spotlight on Rotavirus Vaccine RIX4414 (Rotarix™) in Developed Countries

Plosker¹

2012

Drugs R D

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Incorporating Herd Immunity Effects into Cohort Models of Vaccine Cost-Effectiveness

Abstract: This methodology allows for preliminary assessment of herd immunity effects on CEA of universal vaccination for pediatric infectious diseases. The method requires simple adjustments to an existing cohort model and less data than a full dynamic model.

Cited by 28 publications

References 24 publications

Cost-effectiveness of alternate strategies for childhood immunization against meningococcal disease with monovalent and quadrivalent conjugate vaccines in Canada

Cost-effectiveness of alternate strategies for childhood immunization against meningococcal disease with monovalent and quadrivalent conjugate vaccines in Canada

Modelling the Epidemiology of Infectious Diseases for Decision Analysis

Pharmacoeconomic Spotlight on Rotavirus Vaccine RIX4414 (Rotarix™) in Developed Countries

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