PIN46 Pharmacoeconomic Evaluation of the Introduction of Universal Varicella Vaccination in Italy

Abstract

Due to the possibility to cure the disease, treatment duration in HCV is limited to a maximum of 48 weeks. The lengths of use of direct acting agents (DAA=s) are significantly different: 12 weeks with telaprevir vs. 24, 32 or 44 weeks with boceprevir. These factors make the implementation of futility rules in economic models critical. OBJECTIVES: To provide an insight on the proper application of the futility rules in economic evaluations of DAA=s. METHODS: A decision tree model was developed to assess cost-efficacy for each DAA, considering 4 patient types: naïve, relapsers, partial responders, and null responders. Average acquisition costs have been estimated with and without the use of futility rules; if these rules are used, corresponding salvage treatment costs were included. The efficacy of triple therapy treatment was defined by patient type based on each DAA's summary of product characteristics. Cost per patient with sustained virological response (SVR) and the number of cured and not cured patients was calculated with a fixed budget. RESULTS: For a 10 million EUR investment in each patient type for either DAA, using telaprevir offers maximum cured (726 vs. 587) and minimum non-cured patients (399 vs. 517) if futility rules are not considered. If the futility rules are used, there are still maximum cured patients (759 vs. 734) and minimum non-cured patients (450 vs. 697) when telaprevir is used. We performed one-way and two-way sensitivity analyses and the overall conclusion does not change vs. boceprevir. CONCLUSIONS: Telaprevir offers maximum cured and minimum non-cured patients regardless of the futility rule consideration when compared to boceprevir. If stopping rules are considered in economic evaluations for the treatment of HCV, an appropriate horizon timeline should also be considered to capture future unavoidable costs of non-cured patients: salvage treatment and/or potential disease progression.OBJECTIVES: Invasive Fungal Infections (IFIs) present a major issue in clinical practice, due to their high morbidity and mortality rates. In a pivotal multicentre, randomized clinical trial posaconazole prophylaxis prevented IFIs more effectively than did either fluconazole or itraconazole, and improved overall survival. The aim of this study was to perform an economic evaluation of the afore-mentioned therapeutic strategies for IFI prophylaxis in neutropenic patients, in the Greek health care setting. METHODS: A decision analytic model was developed, which described the course of neutropenic patients under posaconazole or standard azole (fluconazole or itraconazole) treatment. The effectiveness data for each treatment regimen were derived from published results of a pivotal, multicentre, randomized clinical trial. The cost and health care resources utilization data used, depict Greek clinical practice and are derived from official Greek sources. In order to obtain some of the model imputs, expert opinion from Greek Hematologists specializing in treating IFIs, was also used. RESULTS: Prophylaxis with Pos...

Systematic review of economic evaluations of varicella vaccination programmes

“…To address current concerns in childhood vaccination, a range of issues were covered, singly or in various combinations: the effect of taking account of HZ [ 47 , 50 , 53 , 54 , 56 , 59 , 63 , 81 – 83 , 87 , 88 ], the effect of boosting [ 50 , 59 , 81 ], age at second dose [ 53 , 55 ], confining a universal programme to susceptible adolescents [ 64 ], or post exposure prophylaxis [ 31 ]. Some of the studies measuring QALYs focused on simpler issues: a standard programme without herd immunity or HZ [ 68 ], with a package including catchup [ 63 ], with measles, mumps and rubella (MMR) vaccine [ 84 , 85 ] or a simple two dose childhood programme [ 81 ].…”

“…Children eligible for MMR 83,84 ; at 12 months 99 ; at 9 months to 6 years Dose not stated 83,84 ; one dose 99,101 Children at 15 months 49,67 ; those in current programme 50 ; children at 12-18 months 94 Two doses 49,67 , one dose 94 vs no vaccination; current programme 50 Germany BCR 1.75 49 ; 0.82 67 ; 1.75 94 BCR 4.12 49 ; 4.6 67 ; 4.12 94 ; current programme is dominated by do nothing assuming exogenous boosting 50 Children at 12 and 15 months 58 One or two doses vs no vaccination Iran n/a £13,478/DALY (1 dose) £32,394/ DALY (2 doses) cf 14,292/DALY GDP benchmark 58 Susceptible children at 12 months old 72 One dose vs no vaccination Israel BCR 1.63 72 BCR 19.33 72 Children at 15 months and 5-6 years 54 ; infants 71 ; children at 12-15 months and 5 to 6 years 81 ; receiving MMR 85 ; at 1-2 years 89 Two doses 54,81,85 , one dose 71,89 Children at 12 80 , 15 93 months, at 1 and 3 years 75 Two doses vs no vaccination 75,80,93 Spain BCR 1.05 80 ;0.54 93 BCR 1.24 75 ;2.67 80 ;1.61 93 Childr...…”

“…Estimates of incremental cost per QALY gained varied widely, over a range of factors, and cannot always be summarised as a single value. Some studies reported raw values in terms of incremental cost per QALY gained [53,58,59,63,64,68,[83][84][85][86]. 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].…”

“…Van Hoek et al (2012) studied a programme of joint HZ and childhood varicella vaccination and found that 50% of simulations met the local threshold [56]. Sauboin et al (2012) reported a cost-effectiveness estimate of £14,866 per QALY gained from a healthcare perspective [85]. Littlewood et al (2008) reported a similar cost-effectiveness estimate of £14,575 per QALY gained [83].…”