Setting priorities for the Children's Vaccine Initiative: a cost-effectiveness approach

Shepard, Donald S.; Walsh, Julia; Kleinau, E; Stansfield, Sally K.; Bhalotra, Sarita

doi:10.1016/0264-410x(94)00063-s

Cited by 45 publications

(12 citation statements)

References 5 publications

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“…Most studies were conducted in the United States (54%) and Australia (13%), and the remainder were published in Europe and Canada with the exception of 2 studies, which were undertaken from the perspective of sub-Saharan African countries 15 and developing countries in general. 16 Studies were published in 31 different journals, of which Pediatrics was the most common journal with 11 (20%) papers. Studies covered a wide range of conditions with a particular emphasis on infectious and parasitic diseases (n ϭ 21; 39%) and conditions originating in the …”

Section: Number Of Papers Retrieved and Reviewedmentioning

confidence: 99%

Quality-Adjusted Life-Years Lack Quality in Pediatric Care: A Critical Review of Published Cost-Utility Studies in Child Health

Griebsch¹,

Coast

Brown³

2005

Pediatrics

221

171

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ABSTRACT. Objectives. Cost-utility analysis in which health benefits are quantified in terms of qualityadjusted life-years (QALYs) has now become the standard type of cost-effectiveness analysis. These studies are potentially influential in determining the extent of funding for particular pediatric interventions, and so their methodologic quality is extremely important. The objective of this study was twofold: first, to critically appraise published cost-utility analyses of interventions in child and adolescent health care in terms of the methods used to derive QALYs and, second, to discuss unresolved methodologic issues that are pertinent to the measurement of QALYs in pediatric populations.Methods. A comprehensive search using computerized databases (including Medline, Embase, Econlit, and databases specific to economic evaluation), Web searches, and citation tracking was undertaken to identify cost-utility studies of interventions that were aimed at those who were younger than 16 years and published before April 2004. The methods of individual studies were compared with the recognized published guidelines of the US Panel on Cost-Effectiveness in Health and Medicine and the National Institute for Clinical Excellence in England and Wales, which recommend the use of a generic health state classification system (eg, Health Utility Index, EuroQol-5D), a choice-based valuation method (eg, standard gamble or time trade-off) and preferences of the general public in estimating QALYs. Studies therefore were categorized and evaluated according to the methods used to describe the health state, the valuation technique, and source of preferences.Results. Fifty-four studies were reviewed, 34 (63%) of which were published in the past 5 years. A generic health status classification instrument was used in 22 (35%) cases; the remainder developed study-specific health state descriptions or elicited preferences directly from patients or proxies. In 3 (5%) cases, sources were unclear. Preference weights were elicited using choicebased techniques in 28 (42%) cases, either as tariffs for health status classification instruments (17 cases) or by directly valuing health state descriptions or patient health (11 cases). Preferences of the general public were used in only 23 (37%) cases. Four studies aggregated QALYs for mother/child or parents/child pairs without giving any theoretical justification. Although there was an increasing tendency for studies to use generic health status classification instruments, choice-based methods, and preferences of the general public, the majority of studies still did not adhere to these standard recommendations even in the period between January 2000 and March 2004. Despite increasing standardization in the methods advocated for economic evaluation over the past 10 years, there remains extensive variation in the actual methods used by researchers to calculate QALYs for children and adolescents. It is unclear whether these results suggest poor practice or a set of positive (or reactive) choices made by...

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Section: Number Of Papers Retrieved and Reviewedmentioning

confidence: 99%

Quality-Adjusted Life-Years Lack Quality in Pediatric Care: A Critical Review of Published Cost-Utility Studies in Child Health

Griebsch¹,

Coast

Brown³

2005

Pediatrics

221

171

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“…Only a few studies have evaluated pneumococcal vaccines in low-income countries [22-24]. Sinha and colleagues [24] assessed cost-effectiveness of childhood pneumococcal vaccination in the 72 GAVI-eligible countries, based on efficacy data from the Gambian clinical study [8].…”

Section: Introductionmentioning

confidence: 99%

Economic evaluation of pneumococcal conjugate vaccination in The Gambia

2010

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BackgroundGambia is the second GAVI support-eligible country to introduce the 7-valent pneumococcal conjugate vaccine (PCV7), but a country-specific cost-effectiveness analysis of the vaccine is not available. Our objective was to assess the potential impact of PCVs of different valences in The Gambia.MethodsWe synthesized the best available epidemiological and cost data using a state-transition model to simulate the natural histories of various pneumococcal diseases. For the base-case, we estimated incremental cost (in 2005 US dollars) per disability-adjusted life year (DALY) averted under routine vaccination using PCV9 compared to no vaccination. We extended the base-case results for PCV9 to estimate the cost-effectiveness of PCV7, PCV10, and PCV13, each compared to no vaccination. To explore parameter uncertainty, we performed both deterministic and probabilistic sensitivity analyses. We also explored the impact of vaccine efficacy waning, herd immunity, and serotype replacement, as a part of the uncertainty analyses, by assuming alternative scenarios and extrapolating empirical results from different settings.ResultsAssuming 90% coverage, a program using a 9-valent PCV (PCV9) would prevent approximately 630 hospitalizations, 40 deaths, and 1000 DALYs, over the first 5 years of life of a birth cohort. Under base-case assumptions ($3.5 per vaccine), compared to no intervention, a PCV9 vaccination program would cost $670 per DALY averted in The Gambia. The corresponding values for PCV7, PCV10, and PCV13 were $910, $670, and $570 per DALY averted, respectively. Sensitivity analyses that explored the implications of the uncertain key parameters showed that model outcomes were most sensitive to vaccine price per dose, discount rate, case-fatality rate of primary endpoint pneumonia, and vaccine efficacy against primary endpoint pneumonia.ConclusionsBased on the information available now, infant PCV vaccination would be expected to reduce pneumococcal diseases caused by S. pneumoniae in The Gambia. Assuming a cost-effectiveness threshold of three times GDP per capita, all PCVs examined would be cost-effective at the tentative Advance Market Commitment (AMC) price of $3.5 per dose. Because the cost-effectiveness of a PCV program could be affected by potential serotype replacement or herd immunity effects that may not be known until after a large scale introduction, type-specific surveillance and iterative evaluation will be critical.

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“…As discussed above, many other important issues must be included in assessing the usefulness of a particular vaccine. Hib and PCV vaccines were early on regarded as valuable tools in developing countries due to their high VE for invasive disease and proven cost-effectiveness, even before data were available showing impact on all cause pneumonia and – for PCV – mortality [22–24]; consequently, these were some of the first new vaccines supported by the GAVI Alliance. Subsequently, WHO and GAVI supported introduction of rotavirus vaccines, despite their lower VE, due in part to recognition of their VPDI.…”

Section: Discussionmentioning

confidence: 99%

Vaccine preventable disease incidence as a complement to vaccine efficacy for setting vaccine policy

Gessner¹,

Feikin²

2014

Vaccine

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Traditionally, vaccines have been evaluated in clinical trials that establish vaccine efficacy (VE) against etiology-confirmed disease outcomes, a measure important for licensure. Yet, VE does not reflect a vaccine’s public health impact because it does not account for relative disease incidence. An additional measure that more directly establishes a vaccine’s public health value is the vaccine preventable disease incidence (VPDI), which is the incidence of disease preventable by vaccine in a given context. We describe how VE and VPDI can vary, sometimes in inverse directions, across disease outcomes and vaccinated populations. We provide examples of how VPDI can be used to reveal the relative public health impact of vaccines in developing countries, which can be masked by focus on VE alone. We recommend that VPDI be incorporated along with VE into the analytic plans of vaccine trials, as well as decisions by funders, ministries of health, and regulatory authorities.

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Setting priorities for the Children's Vaccine Initiative: a cost-effectiveness approach

Cited by 45 publications

References 5 publications

Quality-Adjusted Life-Years Lack Quality in Pediatric Care: A Critical Review of Published Cost-Utility Studies in Child Health

Quality-Adjusted Life-Years Lack Quality in Pediatric Care: A Critical Review of Published Cost-Utility Studies in Child Health

Economic evaluation of pneumococcal conjugate vaccination in The Gambia

Vaccine preventable disease incidence as a complement to vaccine efficacy for setting vaccine policy

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