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PharmacoEconomics

, Volume 21, Issue 8, pp 587–600 | Cite as

Cost Effectiveness of Pneumococcal Vaccination for Infants and Children with the Conjugate Vaccine PnC-7 in Germany

  • Christa Claes
  • Johann-Matthias Graf von der Schulenburg
Original Research Article

Abstract

Background: The introduction of the conjugate vaccine PnC-7 implies that a pneumococcal vaccine is available, for the first time, which also gives children under the age of 2 years reliable protection against invasive pneumococcal infections and offers some protection against non-invasive pneumococcal infections.

Objective and perspective: In the context of a multiple-period Markov model, a cost-effectiveness analysis of a recommendation for general pneumococcal vaccination in Germany for infants and children under the age of 2 years was performed from the healthcare payer, public authority and societal perspectives.

Design: Various published data on age-specific incidence rates, mortality rates, efficacy of the conjugate vaccine PnC-7 and treatment costs of pneumococcal infections were incorporated into a Markov model to quantify the consequences of vaccinating versus not vaccinating.

Results: From a German healthcare payers’ perspective, general vaccination with the conjugate vaccine would redeem 51.1% of the vaccination costs due to avoidable treatment costs, whereas, from a broader point of view, the benefits, expressed in monetary terms, would exceed the cost of vaccination. The conjugate vaccine would require an investment of €72 866 per life-year saved (discounted, healthcare payers’ viewpoint). Besides this benchmark, there are further outcome measures which cannot be ignored by those deciding on a general vaccination recommendation: 450 000 preventable episodes of illness and 134 cases of sequelae which can be prevented.

Conclusions: The vaccination with the conjugate vaccine PnC-7 is cost saving from a broader perspective and the results should not be ignored by policy makers in regard to a general vaccination recommendation.

Keywords

Otitis Medium Cochlear Implant Conjugate Vaccine Invasive Pneumococcal Disease Cochlear Implantation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

The authors thank Wyeth-Pharma Germany for providing us with information about practitioners’ prescription and retail prices, for organizing interdisciplinary expert meetings and for their financial support of travel expenses and translation. The authors have provided no information on conflicts of interest directly relevant to the content of this study.

References

  1. 1.
    Robert Koch Institut (RKI). Immunisation recommendations of the Standing Committee on Immunisation (STIKO) at Robert Koch-Institut/Stand: Juli 2001. Epidemiol Bull 2001; 28: 203–18Google Scholar
  2. 2.
    Lieu TA, Ray GT, Black SB, et al. Projected cost-effectiveness of pneumococcal conjugate vaccination of healthy infants and young children. JAMA 2000; 283 (11): 1460–8PubMedCrossRefGoogle Scholar
  3. 3.
    Hanoveraner Consensus Group. German recommendations regarding to health-economic evaluation: revised version of the Hanoverian Consensus [in German]. Gesundheitsökonomie and Qualitätsmanagement 1999; 4: A62–5Google Scholar
  4. 4.
    Adam D. Pneumococcal illnesses (meningitis, pneumonia, sepsis) in infancy from clinical view [in German]. In: Stdck B, Voβ H, editors. Pneumococcal illnesses of babies and toddlers [in German]. Marburg: Verlag im Kilian, 2001: 11–14Google Scholar
  5. 5.
    Ziebold C, von Kries R, Siedler A, et al. Epidemiology of pneumococcal disease in children in Germany. Acta Paediatr Suppl 2000; 89 (435): 17–21PubMedCrossRefGoogle Scholar
  6. 6.
    Rosenblut A, Santolaya ME, Gonzalez P, et al. Bacterial and viral etiology of acute otitis media in Chilean children. Pediatr Infect Dis J 2001; 20 (5): 501–7PubMedCrossRefGoogle Scholar
  7. 7.
    Von Kries R, Siedler A, Schmitt HJ, et al. Proportion of invasive pneumococcal infections in German children preventable by pneumococcal conjugate vaccines. Clin Infect Dis 2000; 31 (2): 482–7CrossRefGoogle Scholar
  8. 8.
    Siedler A. Illnesses by pneumococcus: epidemiological situation in Germany (Emphasis invasive illnesses) [in German]. In: Stuck B, Voβ H, editors. Pneumococcal illnesses of babies and toddlers [in German]. Marburg: Verlag im Kilian, 2001: 44–53Google Scholar
  9. 9.
    Eskola J, Kilpi T, Palmu A, et al. Efficacy of a pneumococcal conjugate vaccine against acute otitis media. N Engl J Med 2001; 344 (6): 403–9PubMedCrossRefGoogle Scholar
  10. 10.
    Von Kries R, Hermann M, Al-Lahham A, et al. Will the 7-valent pneumococcal vaccine have a similar impact on all invasive pneumococcal infections in children in Germany as in the Kaiser Permanente Trial? Eur J Pediatr 2002; 161 Suppl. 2: S140–3CrossRefGoogle Scholar
  11. 11.
    Black SB, Shinefield HR, Ling S, et al. Effectiveness of heptavalent pneumococcal conjugate vaccine in children younger than five years of age for prevention of pneumonia. Pediatr Infect Dis J 2002 Sep; 21 (9): 810–5PubMedCrossRefGoogle Scholar
  12. 12.
    Müller-Werdan A, Werdan K. Therapy of sepsis — a position reckoning [in German]. Arzneimitteltherapie 1999; 4: 126Google Scholar
  13. 13.
    Schmöle-Thoma B. Efficacy and compatibility of the pneumococcal conjugate vaccines [in German]. In: Stuck B, Voβ H, editors. Pneumococcal illnesses of babies and toddlers [in German]. Marburg: Verlag im Kilian, 2001: 72–78Google Scholar
  14. 14.
    Homepage of IMS Health [online]. Available from URL: http://www.imshealth.de [Accessed 2003 Jan 30]
  15. 15.
    Adam D, Scholz H. Efficacy of pneumococcal conjugate vaccine in children [in German]. Klinische Padiatrie 2001; 213 (3): 109–13PubMedCrossRefGoogle Scholar
  16. 16.
    Baraff LJ, Lee SI, Schriger OL. Outcomes of bacterial meningitis in children: a meta-analysis. Pediatr Infect Dis J 1993; 12 (5): 389–94PubMedCrossRefGoogle Scholar
  17. 17.
    Louvois J de, Bedford H, Peckham C, et al. Epidemiology of infantile meningitis: results from a five-year prospective follow-up of 1721 survivors of meningitis in the first year of life [abstract 12]. 19th Annual Meeting of the European Society for Paediatric Infectious Diseases (ESPID); 2001 Mar 26–28; IstanbulGoogle Scholar
  18. 18.
    Statistisches Bundesamt (Federal Statistical Office), editor. Health report for Germany [in German]. Wiesbaden: Metzler-Poeschel, 1998: 235Google Scholar
  19. 19.
    Black S, Shinefield H, Fireman B, et al. Efficacy, safety and immunogenicity of heptavalent pneumococcal conjugate vaccine in children: Northern California Kaiser Permanente Vaccine Study Center Group. Pediatr Infect Dis J 2000; 19: 187–95PubMedCrossRefGoogle Scholar
  20. 20.
    Von Kries R, Hermann M, Hachmeister A, et al. Prediction of the potential benefit of different pneumococcal conjugate vaccines on invasive pneumococcal disease in German children. Pediatr Infect Dis J 2002; 21 (1): 1017–23CrossRefGoogle Scholar
  21. 21.
    Fireman B, Black SB, Shinefield HR, et al. Impact of the pneumococcal conjugate vaccine on otitis media. Pediatr Infect Dis J 2003; 22 (1): 10–6PubMedCrossRefGoogle Scholar
  22. 22.
    Wenzel RP. Antiendotoxin monoclonal antibodies: a second look. N Engl J Med 1992; 326: 1151–2PubMedCrossRefGoogle Scholar
  23. 23.
    Zok K. Hearing aids in competition. Channels of supply in comparison [in German]. Bonn: Research Institute of the Local Healthcare Funds (WIdO), 2001Google Scholar
  24. 24.
    Schulze-Gattermann H. Cost benefit-analysis of Cochlear implantation with children [dissertation] [in German]. Hanover: Medical School of Hanover, 2000Google Scholar
  25. 25.
    Schulze-Gattermann H, Illg A, Schoenermark M, et al. Costbenefit analysis of pediatric cochlear implantation: German experience. Otol Neurotol 2002 Sep; 23 (5): 674–81PubMedCrossRefGoogle Scholar
  26. 26.
    Ley S, Quasi U. Summary of the most important results of the workshop [in German]. In: Stuck B, Vob H, editors. Pneumococcal illnesses of babies and toddlers [in German]. Marburg: Verlag im Kilian, 2001: 83–93Google Scholar
  27. 27.
    Zi Koeln homepage. Available from URL: http://www.zikoeln.de [Accessed 2003 Jan 30]
  28. 28.
    German Social Court. Judgement in the law case. Reference: B 6 KA 14/98 R from 1999 Aug 25Google Scholar
  29. 29.
    Federal Statistical Office Germany, editor. Health care, Fachserie 12, Reihe 6.2, Diagnostic data of the inpatients [in German]. Wiesbaden: Metzler-Poeschel, 1998Google Scholar
  30. 30.
    Overturf GD and Committee on Infectious Diseases. Prevention of pneumococcal infections, including the use of pneumococcal conjugate and polysaccharide vaccines and antibiotic prophylaxis [technical report]. Pediatrics 2000; 106 (2): 367–76CrossRefGoogle Scholar
  31. 31.
    Federal State Audit Court of Lower Saxony. Message to the Ministry for Women’s Issues and Social Affairs of Lower Saxony, Ministry of Education and Arts of Lower Saxony, regional authorities for Central Social Functions: about the cross section check of the regional education centers [in German]. Hildesheim: Selfprint, ed. 1999Google Scholar
  32. 32.
    Schulenburg JM Graf v d, Greiner W, Schöffski O. Recommendations regarding to health-economic evaluation: Hanoverian Consensus [in German]. Zeitschrift für Allgemeinmedizin 1996; 72: 485–90Google Scholar
  33. 33.
    Federal Statistical Office Germany. National accounts: important overall economic sizes and gainful employment [in German]. Wiesbaden, 2000. Available from URL: http://www.destatis.de/basis/d/vgr/vgrtabl0.htm and from from URL: http://www.destatis.de/basis/d/erwerb/erwerbtabl.htm [Accessed 2002 Jan 30]
  34. 34.
    Federal Statistical Office Germany. Micro censuses 1998: labour participation of mothers. Approximately 60% of the mothers with children less than 18 years are gainfully employed [in German]. Wiesbaden, 1999. Available from URL: Available from URL: http://www.destatis.de/presse/deutsch/pm1996/p0700031.htm [Accessed 2002 Jan 30]
  35. 35.
    Lazaro A. Theoretical arguments for the discounting of health consequences. Pharmacoeconomics 2002; 20 (14): 943–61PubMedCrossRefGoogle Scholar
  36. 36.
    Wald ER. Sinusitis in children. N Engl J Med 1992; 326 (5): 319–23PubMedCrossRefGoogle Scholar
  37. 37.
    Whitney CG, Farley MM, Hadler J, et al. Decline in invasive pneumococcal disease in the US in 2000: an effect of pneumococcal conjugate vaccine? [abstract]. Centers for Disease Control and Prevention (CDC). Atlanta (GA); 2 Emerging Infections Program, ICAAC 2001, G2041Google Scholar

Copyright information

© Adis International Limited 2003

Authors and Affiliations

  • Christa Claes
    • 1
  • Johann-Matthias Graf von der Schulenburg
    • 1
  1. 1.Institute for Insurance EconomicsUniversity of HannoverHannoverGermany

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