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

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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.

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References

  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: 203–18

    Google Scholar 

  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): 1460–8

    Article  PubMed  CAS  Google Scholar 

  3. Hanoveraner Consensus Group. German recommendations regarding to health-economic evaluation: revised version of the Hanoverian Consensus [in German]. Gesundheitsökonomie and Qualitätsmanagement 1999; 4: A62–5

    Google Scholar 

  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: 11–14

    Google Scholar 

  5. Ziebold C, von Kries R, Siedler A, et al. Epidemiology of pneumococcal disease in children in Germany. Acta Paediatr Suppl 2000; 89 (435): 17–21

    Article  PubMed  CAS  Google Scholar 

  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): 501–7

    Article  PubMed  CAS  Google Scholar 

  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): 482–7

    Article  Google Scholar 

  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: 44–53

    Google Scholar 

  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): 403–9

    Article  PubMed  CAS  Google Scholar 

  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: S140–3

    Article  Google Scholar 

  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): 810–5

    Article  PubMed  Google Scholar 

  12. Müller-Werdan A, Werdan K. Therapy of sepsis — a position reckoning [in German]. Arzneimitteltherapie 1999; 4: 126

    Google Scholar 

  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: 72–78

    Google Scholar 

  14. Homepage of IMS Health [online]. Available from URL: http://www.imshealth.de [Accessed 2003 Jan 30]

  15. Adam D, Scholz H. Efficacy of pneumococcal conjugate vaccine in children [in German]. Klinische Padiatrie 2001; 213 (3): 109–13

    Article  PubMed  CAS  Google Scholar 

  16. Baraff LJ, Lee SI, Schriger OL. Outcomes of bacterial meningitis in children: a meta-analysis. Pediatr Infect Dis J 1993; 12 (5): 389–94

    Article  PubMed  CAS  Google Scholar 

  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; Istanbul

  18. Statistisches Bundesamt (Federal Statistical Office), editor. Health report for Germany [in German]. Wiesbaden: Metzler-Poeschel, 1998: 235

    Google Scholar 

  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: 187–95

    Article  PubMed  CAS  Google Scholar 

  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): 1017–23

    Article  Google Scholar 

  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): 10–6

    Article  PubMed  Google Scholar 

  22. Wenzel RP. Antiendotoxin monoclonal antibodies: a second look. N Engl J Med 1992; 326: 1151–2

    Article  PubMed  CAS  Google Scholar 

  23. Zok K. Hearing aids in competition. Channels of supply in comparison [in German]. Bonn: Research Institute of the Local Healthcare Funds (WIdO), 2001

    Google Scholar 

  24. Schulze-Gattermann H. Cost benefit-analysis of Cochlear implantation with children [dissertation] [in German]. Hanover: Medical School of Hanover, 2000

    Google Scholar 

  25. Schulze-Gattermann H, Illg A, Schoenermark M, et al. Costbenefit analysis of pediatric cochlear implantation: German experience. Otol Neurotol 2002 Sep; 23 (5): 674–81

    Article  PubMed  Google Scholar 

  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: 83–93

    Google Scholar 

  27. Zi Koeln homepage. Available from URL: http://www.zikoeln.de [Accessed 2003 Jan 30]

  28. German Social Court. Judgement in the law case. Reference: B 6 KA 14/98 R from 1999 Aug 25

  29. Federal Statistical Office Germany, editor. Health care, Fachserie 12, Reihe 6.2, Diagnostic data of the inpatients [in German]. Wiesbaden: Metzler-Poeschel, 1998

    Google Scholar 

  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): 367–76

    Article  Google Scholar 

  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. 1999

  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: 485–90

    Google Scholar 

  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. 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. Lazaro A. Theoretical arguments for the discounting of health consequences. Pharmacoeconomics 2002; 20 (14): 943–61

    Article  PubMed  Google Scholar 

  36. Wald ER. Sinusitis in children. N Engl J Med 1992; 326 (5): 319–23

    Article  PubMed  CAS  Google Scholar 

  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, G2041

    Google Scholar 

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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.

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  1. Institute for Insurance Economics, University of Hannover, Koenigsworther Platz 1, Hannover, D-30167, Germany

    Christa Claes & Johann-Matthias Graf von der Schulenburg

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  1. Christa Claes
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  2. Johann-Matthias Graf von der Schulenburg
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Correspondence to Christa Claes.

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Claes, C., von der Schulenburg, JM.G. Cost Effectiveness of Pneumococcal Vaccination for Infants and Children with the Conjugate Vaccine PnC-7 in Germany. Pharmacoeconomics 21, 587–600 (2003). https://doi.org/10.2165/00019053-200321080-00005

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