Pin25 Cost-Effectiveness Analysis of the Introduction of the Varicella Vaccine in Colombia

Abstract

the model is robust to a wide range of parameter estimates. CONCLUSIONS: This analysis suggests that the use of ATVϩRTV in the Mexican healthcare setting is a preferred option when compared to LPVϩRTV for treatment of treatment-naïve HIV patients. OBJECTIVES:To examine the incremental cost-effectiveness of palivizumab vs. no prophylaxis among 3 groups of preterm infants in a Medicaid population. Infants were Յ6 months of age at the start of the RSV season: 1) Յ32 weeks gestational age (wGA); 2) High-risk (HR) 32-35 wGA (Ն 2 risk factors) or 3) Low-risk (LR) 32-35 wGA (Յ1 risk factor). METHODS: We conducted a cost-utility analysis of palivizumab from a societal perspective based on 5 monthly doses throughout the RSV season. Medicaid-related inputs included the background rates of RSV disease, marginal healthcare costs within the first two years of life between infants with RSV compared to controls, and the estimated public payer dollars spent for palivizumab. The base case included recurrent wheezing (RW), which was excluded during sensitivity analysis. We report the incremental cost-effectiveness ratio (ICER), morbidity, and mortality between the prophylaxed and non-prophylaxed groups. RESULTS: Prophylaxis among Ͻ32 wGA infants was dominant, with and without RW. For HR 32-35 wGA infants, the ICER was $3,791/QALY with RW and $26,290/ QALY without RW. For LR 32-35 wGA infants, the ICER was $22,690/QALY with RW and $231,784/QALY without RW. Compared with infants without prophylaxis, infants receiving prophylaxis were projected to have fewer RSV hospitalizations (-4214 among Ͻ32 wGA, Ϫ4734 among HR 32-35 wGA, and Ϫ1289 among LR 32-35 wGA infants) among the estimated 119,500 premature births in Medicaid in the US. Likewise, prophylaxis was estimated to reduce the number of deaths by 42 among Ͻ32 wGA, 74 among HR 32-35wGA and 20 among LR 32-35 wGA infants. CONCLUSIONS: Palivizumab was shown to be highly cost-effective among infants Ͻ32 wGA and HR 32-35 wGA due to Medicaid's lower cost structure for healthcare items and services and higher rates of disease compared to private plans. The study was sponsored by MedImmune, LLC.

Burden of varicella in Latin America and the Caribbean: findings from a systematic literature review

“…Three studies provided economic evaluations of vaccination prior to the introduction of universal vaccination programs in Colombia [64, 65] and Brazil [63]. All three studies utilized a decision analysis model, but each study was conducted with a different perspective: societal [63], payer [65], or provider [64]. The time horizon was 30 years in all studies.…”

“…In a second study in the Colombian setting, De La Hoz et al [65] concluded that the varicella cost with vaccination was lower than the varicella cost without vaccination (US $35 million vs. US $88 million in 2008 [equivalent to US $40.6 million vs.…”

“…US $88 million in 2008 [equivalent to US $40.6 million vs. US $102.2 million in 2017]), resulting in an incremental cost-utility ratio of US $2527 per life-year gained (LYG) in 2008 [equivalent to US $2934.4 per LYG in 2017] [65].…”

Systematic review of economic evaluations of varicella vaccination programmes

“…Others, having compared incremental cost per QALY results with a local threshold of acceptable cost per QALY, reported whether the threshold had been satisfied or not [ 51 , 53 , 56 , 58 , 59 , 61 , 64 , 68 , 87 ]. Yet others reported whether there was a dominant option in the sense of having a higher level of QALYs and lower cost than a comparator [ 16 , 53 , 54 , 57 , 59 , 62 , 65 , 81 , 83 , 84 , 88 ]. There were examples of disparate findings emerging from studies which apparently have much in common [ 59 , 64 ].…”

“…However, it is uncertain whether vaccination costs were included in these studies. Four studies reported incremental cost per life year gained or incremental cost per death prevented, but not incremental cost per QALY gained or a benefit-cost ratio [ 65 , 70 , 77 , 102 , 103 ]. Since death, though not unknown, is uncommon in varicella, we would expect these costs to be high.…”