To estimate cost-effectiveness of routine and catch-up vaccination of Canadian children with seven-valent pneumococcal conjugate vaccine, a simulation model was constructed. In base scenario (vaccination coverage: 80%, and vaccine price: 58 dollars per dose), pneumococcal disease incidence reduction would be superior to 60% for invasive infections, and to 30% for non-invasive infections, but the number of deaths prevented would be small. Annual costs of routine immunization would be 71 million dollars (98% borne by the health system). Societal benefit to cost ratio would be 0.57. Net societal costs per averted pneumococcal disease would be 389 dollars and 125,000 per life-year gained (LYG). Vaccine purchase cost is the most important variable in sensitivity analyses, and program costs would be superior to societal benefits in all likely scenarios. Vaccination would result in net savings for society, if vaccine cost is less than 30 dollars per dose. Economic indicators of catch-up programs are less favorable than for routine infant immunization.
In the province of Quebec, Canada, the pneumococcal 7-valent conjugate vaccine (PCV-7) was licensed in 2001 and a publicly funded program was implemented in 2004, recommending 3 doses for healthy children. An economic analysis was performed both from a health care and societal perspective. Outcomes possibly prevented by PCV-7 and observed in 2006-2007 were compared to expected frequencies based on rates measured before PCV-7 use. Annual program costs were close to $21M for the health system and $23M for society. Approximately 20,000 infections were prevented annually and estimated economic benefits were $5M for the health system and $23M for society, using a 3% per annum discounting rate. The incremental cost-effectiveness ratio was $18,000 per QALY gained for the health system and the program was close to the break-even threshold in a societal perspective.
This study compares the cost-effectiveness of a control strategy for serogroup C meningococcal disease (CMD) relying on surveillance and implementation of a mass immunization campaign effective 1 year after the beginning of an epidemic with strategies based on routine immunization, using either three doses of serogroup C conjugate vaccine given in early infancy or one dose at 1 year of age. The simulation model is based on 25 birth cohorts followed up to age 24 years, and seven epidemiological scenarios including low and high level endemicity, and one to five epidemics over a 49-year period. Epidemiological and cost data were mainly collected in the province of Quebec, Canada. Results indicate that the most effective strategy is a three-dose routine program, with the least effective strategy being mass immunization. A one-dose routine program is the most cost-effective strategy in most likely scenarios. In a societal perspective with a vaccine purchase price of CDN$ 50 per dose, the average incremental cost of the one-dose strategy would be $ 190,000 per case averted, US$ 23,000 per life-year gained, and US$ 42,000 per QALY gained. If vaccine-induced immunity is waning rapidly, mass immunization or routine vaccination with booster dose(s) would be the best control options.
The objective of the study was to evaluate the cost-effectiveness and utility of the mass immunization campaign performed in the province of Quebec in 1992-1993, following an outbreak of serogroup C meningococcal disease (CMD). Effectiveness data were extracted from a population-based cohort study, and cost estimates were obtained from surveys. Costs of the campaign to the health system were $ 26 million (1993 Canadian dollars). Between 48 and 74 CMD cases, and between 7 and 11 deaths were prevented in the following 5 years. Net societal costs were between $ 18 and 21 million (using a 3% discount rate), net costs per death averted were between $ 1.7 and 3.0 million, between $ 58,000 and 105,000 per life-year gained, and between $ 49,000 and 87,000 per quality-adjusted life-year gained. These economic indices are less favorable than those for current routine immunization programs in Canada, but within the range of those for other common health interventions.
In 1994, immunization against hepatitis B was implemented in schools in Quebec, targeting grade 4 students. In 1996-1997 and 1997-1998, one Local Community Service Centre (CLSC) replaced the school-based program in its district with vaccination offered in community clinics after school hours. The aim of the current study was to compare the effectiveness and costs of school-based and clinic-based programs.
Vaccination coverage data were collected in the CLSC with the clinic-based program (CBP), and in three matched CLSCs with a school-based program (SBP), from 1994 to 2000. Surveys were conducted to estimate costs to parents, to schools and to CLSCs in 1997-1998.
With the implementation of the CBP, the vaccination coverage fell to 73%, compared with over 90% in the SBPs. Coverage increased to 90% when the CBP was abandoned. Costs to the CLSC were not much lower in the CBP. Societal costs were $63 per student vaccinated in the CBP, and
Several outbreaks caused by virulent strains of serogroup C Neisseria meningitidis were observed in several Canadian provinces in the early 1990s. In an attempt to control these outbreaks, local immunization programs, with polysaccharide vaccines, directed at school age children and adolescents were initiated. In Quebec, however, the incidence of serogroup C meningococcal disease remained high among unvaccinated groups, and clusters appeared in previously unaffected areas. As a result, a 1-dose immunization campaign was initiated, targeting all 1.9 million people between 6 months and 20 years of age for vaccination with the polysaccharide vaccine. This campaign was effective in controlling the epidemic, but there was no evidence of vaccine effectiveness among children
In Canada, publicly funded immunization programs are a provincial/territorial responsibility. In the province of Quebec, much effort has been devoted to optimize the acceptability, effectiveness and cost-effectiveness of publicly funded immunization programs for children during the last 20 years. The aim of this article is to describe how programs are planned, implemented and evaluated and to identify key factors that contribute to the success of this enterprise. A comprehensive framework was developed for the evaluation of new vaccines and new programs in a societal perspective. It is used by the Quebec Immunization Committee to prepare reports proposing options with their costs and consequences for the public health authority. When a decision is made, the implementation of the new program is carefully planned. Surveys and consultations with stakeholders are systematically conducted to identify potential obstacles. A fraction of the budget is always reserved for program evaluation and monitoring. At the present time, the recommended immunization schedule targets 15 different diseases and only 20 injections are offered up to 15 years of age. Vaccine uptake rate is high and, although a reduced number of doses are recommended for several vaccines, program effectiveness is highly satisfactory, as shown for hepatitis B, meningococcal and pneumococcal diseases.
Clinical trials have shown prophylactic human papillomavirus (HPV) vaccines to be effective against infection and disease. We examined whether HPV vaccination has the potential to be cost-effective.
A cohort model of the natural history of HPV was developed, which fits simultaneously Canadian age and type-specific data for infection, cervical intraepithelial neoplasia, cervical cancer (CC) and genital warts (GW). Quality-Adjusted Life-Years (QALYs) lost and costs were estimated using data from the literature.
Vaccinating 12-year-old girls (efficacy=95%, no waning, cost/course=CAN$ 400) against HPV-16/18 and HPV-6/11/16/18 is estimated to cost the health provider CAN$ 31,000 (80%CrI: 15,000-55,000) and CAN$ 21,000 (80%CrI: 11,000-33,000) per QALY-gained, respectively. Results were most sensitive to age at vaccination, duration of vaccine protection, vaccine cost and QALY-lost due to GW, and were least sensitive to the medical costs.
Vaccinating adolescent girls against HPV is likely to be cost-effective. The main benefit of vaccination will be in reducing CC mortality. However, unless screening is modified, the treatment costs saved through vaccination will be insignificant compared to the cost of HPV immunization.
Comment In: Vaccine. 2007 Nov 7;25(45):771717919785
A clinical trial has shown that a live-attenuated varicella-zoster virus vaccine is effective against herpes zoster (HZ) and post-herpetic neuralgia (PHN). The aim of this study was to examine the cost-effectiveness of vaccination against HZ and PHN in Canada. A cohort model was developed to estimate the burden of HZ and the cost-effectiveness of HZ vaccination, using Canadian population-based data. Different ages at vaccination were examined and probabilistic sensitivity analysis was performed. The economic evaluation was conducted from the ministry of health perspective and 5% discounting was used for costs and benefits. In Canada (population = 30 million), we estimate that each year there are 130,000 new cases of HZ, 17,000 cases of PHN and 20 deaths. Most of the pain and suffering is borne by adults over the age of 60 years and is due to PHN. Vaccinating 65-year-olds (HZ efficacy = 63%, PHN efficacy = 67%, no waning, cost/course = $150) is estimated to cost $33,000 per QALY-gained (90% CrI: 19,000-63,000). Assuming the cost per course of HZ vaccination is $150, probabilistic sensitivity analysis suggest that vaccinating between 65 and 75 years of age will likely yield cost-effectiveness ratios below $40,000 per Quality-Adjusted Life-Year (QALY) gained, while vaccinating adults older than 75 years will yield ratios less than $70,000 per QALY-gained. These results are most sensitive to the duration of vaccine protection and the cost of vaccination. In conclusion, results suggest that vaccinating adults between the ages of 65 and 75 years is likely to be cost-effective and thus to be a judicious use of scarce health care resources.
One dose of serogroup C meningococcal conjugate vaccine (MCV-C) at 12 months of age is the most common immunization schedule in Canada, but immunity may wane over time.
To assess the cost-effectiveness of a booster dose at 12 years of age with either MCV-C or a quadrivalent ACYW135 meningococcal conjugate vaccine (MCV-4).
A simulation model for assessing both the direct and indirect effects of vaccination was developed. Age- and serogroup-specific incidence and fatality rates were derived from Canadian surveillance data. Vaccine efficacy was estimated from data from the U.K. and Spain, assuming an age-dependent decline of vaccine efficacy over time. Expected vaccine coverage rates were 90% at 12 months, and 70% at 12 years. Herd immunity was modeled using UK data. Vaccine purchase price per dose was $23 for MCV-C and $70 for MCV-4. Costs and health outcomes were discounted at 3% per year. Results, expressed in 2004 Canadian $ and from a societal perspective, were presented for a steady state situation and a population of 1 million.
Under the "no vaccination" base scenario, 5.7 cases of vaccine-preventable meningococcal disease would occur each year. Vaccination at 12 months using MCV-C would reduce the burden of disease by 32%. Adding MCV-C at 12 years of age would reduce the number of cases by 55% at no marginal cost, while using MCV-4 would result in a disease reduction of 78% for a marginal cost of $31000 per QALY gained. Comparing MCV-4 with MCV-C as a booster dose, the incremental cost-effectiveness ratio would be $113000 per QALY. The efficacy of C-MCV vaccination at 12 months and the differential price between the two vaccines were the parameters having the strongest impact on the cost/QALY ratios. Any increase in the incidence of serogroup Y will improve the marginal cost-effectiveness ratio associated with MCV-4.
Adolescent revaccination would be beneficial. Using C-MCV would be the most cost-effective option, while using MCV-4 would be more effective but would also require more investment.