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Benefits and costs of immunization of children with pneumococcal conjugate vaccine in Canada.

https://arctichealth.org/en/permalink/ahliterature184064
Source
Vaccine. 2003 Sep 8;21(25-26):3757-64
Publication Type
Article
Date
Sep-8-2003
Author
Philippe De Wals
Geneviève Petit
Lonny James Erickson
Maryse Guay
Theresa Tam
Barbara Law
Alicia Framarin
Author Affiliation
Department of Social and Preventive Medicine, Laval University, Quebec City, Que., Canada G1K 7P4. philippe.dewals@msp.ulaval.ca
Source
Vaccine. 2003 Sep 8;21(25-26):3757-64
Date
Sep-8-2003
Language
English
Publication Type
Article
Keywords
Algorithms
Canada - epidemiology
Child
Child, Preschool
Computer simulation
Cost of Illness
Cost-Benefit Analysis
Databases, Factual
Drug Costs
Female
Humans
Immunization Programs - economics
Immunization, Secondary - economics
Infant
Male
Models, Economic
Pneumococcal Infections - economics - epidemiology - prevention & control
Pneumococcal Vaccines - economics - immunology
Vaccines, Conjugate - economics - immunology
Abstract
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.
PubMed ID
12922109 View in PubMed
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Cost-effectiveness of a 3-dose pneumococcal conjugate vaccine program in the province of Quebec, Canada.

https://arctichealth.org/en/permalink/ahliterature148331
Source
Vaccine. 2009 Nov 23;27(50):7105-9
Publication Type
Article
Date
Nov-23-2009
Author
Béatrice Poirier
Philippe De Wals
Geneviève Petit
Lonny J Erickson
Jacques Pépin
Author Affiliation
Department of Community Health Sciences, University of Sherbrooke, Sherbrooke, Canada.
Source
Vaccine. 2009 Nov 23;27(50):7105-9
Date
Nov-23-2009
Language
English
Publication Type
Article
Keywords
Cost-Benefit Analysis
Health Care Costs
Humans
Immunization Programs - economics
Models, Economic
Pneumococcal Infections - economics - prevention & control
Pneumococcal Vaccines - economics
Quality-Adjusted Life Years
Quebec
Vaccines, Conjugate - economics
Abstract
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.
PubMed ID
19786137 View in PubMed
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Cost-effectiveness of immunization strategies for the control of serogroup C meningococcal disease.

https://arctichealth.org/en/permalink/ahliterature181254
Source
Vaccine. 2004 Mar 12;22(9-10):1233-40
Publication Type
Article
Date
Mar-12-2004
Author
Philippe De Wals
Van Hung Nguyen
Lonny J Erickson
Maryse Guay
Jean Drapeau
Jennifer St-Laurent
Author Affiliation
Department of Social and Preventive Medicine, Laval University, Pavillon de l'Est, 2180 chemin Sainte-Foy, Quebec, Que., Canada G1K 7P4. philippe.dewals@msp.ulaval.ca
Source
Vaccine. 2004 Mar 12;22(9-10):1233-40
Date
Mar-12-2004
Language
English
Publication Type
Article
Keywords
Cost-Benefit Analysis
Humans
Mass Vaccination - economics
Meningitis, Meningococcal - economics - epidemiology - immunology
Meningococcal Vaccines - economics - immunology
Neisseria meningitidis, Serogroup C - immunology
Quebec - epidemiology
Vaccines, Conjugate - immunology
Abstract
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.
PubMed ID
15003652 View in PubMed
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Economic analysis of the 1992-1993 mass immunization campaign against serogroup C meningococcal disease in Quebec.

https://arctichealth.org/en/permalink/ahliterature189452
Source
Vaccine. 2002 Jun 21;20(21-22):2840-4
Publication Type
Article
Date
Jun-21-2002
Author
Philippe De Wals
Lonny Erickson
Author Affiliation
Department of Community Health Sciences, University of Sherbrooke, 3001 12th Avenue North, Sherbrooke, Quebec, Canada J1H 5N4. Philippe.Dewals@msp.ulaval.ca
Source
Vaccine. 2002 Jun 21;20(21-22):2840-4
Date
Jun-21-2002
Language
English
Publication Type
Article
Keywords
Cohort Studies
Community Health Services - economics
Cost-Benefit Analysis
Health Care Costs
Humans
Immunization
Mass Vaccination - economics - methods
Meningococcal Infections - economics - epidemiology - prevention & control
Meningococcal Vaccines - administration & dosage - economics
Polysaccharides, Bacterial - immunology
Quebec - epidemiology
Treatment Outcome
Abstract
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.
PubMed ID
12102036 View in PubMed
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Effectiveness and cost comparison of two strategies for hepatitis B vaccination of schoolchildren.

https://arctichealth.org/en/permalink/ahliterature186677
Source
Can J Public Health. 2003 Jan-Feb;94(1):64-7
Publication Type
Article
Author
Maryse Guay
Anne-Marie Clouâtre
Manon Blackburn
Geneviève Baron
Philippe De Wals
Chantale Roy
Jean Desrochers
François Milord
Author Affiliation
Direction de la santé publique, de la planification et de l'évaluation, Régie régionale de la santé et des services sociaux de la Montérégie, Longueuil, QC. m.guay@rrss16@gouv.qc.ca
Source
Can J Public Health. 2003 Jan-Feb;94(1):64-7
Language
English
Publication Type
Article
Keywords
Child
Community Health Centers - economics - standards
Cost-Benefit Analysis
Female
Hepatitis B - prevention & control
Hepatitis B Vaccines - administration & dosage - economics
Humans
Immunization Programs - economics - organization & administration - utilization
Male
Program Evaluation
Quebec
School Health Services - economics - standards
Abstract
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
PubMed ID
12583682 View in PubMed
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Meningococcal C vaccines: the Canadian experience.

https://arctichealth.org/en/permalink/ahliterature176998
Source
Pediatr Infect Dis J. 2004 Dec;23(12 Suppl):S280-4
Publication Type
Article
Date
Dec-2004
Author
Philippe De Wals
Author Affiliation
Department of Social and Preventive Medicine, Laval University and Quebec National Public Health Institute, Quebec, Canada. philippe.dewals@msp.ulaval.ca
Source
Pediatr Infect Dis J. 2004 Dec;23(12 Suppl):S280-4
Date
Dec-2004
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Canada - epidemiology
Child
Child, Preschool
Cost-Benefit Analysis
Disease Outbreaks
Humans
Immunization Schedule
Infant
Mass Vaccination - economics
Meningococcal Infections - epidemiology - prevention & control
Meningococcal Vaccines - administration & dosage - immunology
Neisseria meningitidis, Serogroup C - immunology
Abstract
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
PubMed ID
15597070 View in PubMed
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Optimizing the acceptability, effectiveness and costs of immunization programs: the Quebec experience.

https://arctichealth.org/en/permalink/ahliterature138598
Source
Expert Rev Vaccines. 2011 Jan;10(1):55-62
Publication Type
Article
Date
Jan-2011
Author
Philippe De Wals
Author Affiliation
Department of Social and Preventive Medicine, Laval University, 1050 Avenue de la Médecine, Quebec City, G1V 0A6, Canada. philippe.dewals@msp.ulaval.ca
Source
Expert Rev Vaccines. 2011 Jan;10(1):55-62
Date
Jan-2011
Language
English
Publication Type
Article
Keywords
Communicable Disease Control - economics - methods
Cost-Benefit Analysis
Hepatitis B - epidemiology - prevention & control
Humans
Immunization Programs - economics - organization & administration
Meningococcal Infections - epidemiology - prevention & control
Patient Acceptance of Health Care
Pneumococcal Infections - epidemiology - prevention & control
Program Evaluation - economics
Quebec
Abstract
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.
PubMed ID
21162621 View in PubMed
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The potential cost-effectiveness of prophylactic human papillomavirus vaccines in Canada.

https://arctichealth.org/en/permalink/ahliterature163089
Source
Vaccine. 2007 Jul 20;25(29):5399-408
Publication Type
Article
Date
Jul-20-2007
Author
Marc Brisson
Nicolas Van de Velde
Philippe De Wals
Marie-Claude Boily
Author Affiliation
Département de médecine sociale et préventive, Université Laval, Que., Canada. marc.brisson@uresp.ulaval.ca
Source
Vaccine. 2007 Jul 20;25(29):5399-408
Date
Jul-20-2007
Language
English
Publication Type
Article
Keywords
Canada
Cervical Intraepithelial Neoplasia - economics - prevention & control
Child
Condylomata Acuminata - economics - prevention & control
Cost-Benefit Analysis
Female
Humans
Multivariate Analysis
Papillomavirus Infections - economics - prevention & control
Papillomavirus Vaccines - economics
Uterine Cervical Neoplasms - economics - prevention & control
Abstract
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.
Notes
Comment In: Vaccine. 2007 Nov 7;25(45):771717919785
PubMed ID
17561316 View in PubMed
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The potential cost-effectiveness of vaccination against herpes zoster and post-herpetic neuralgia.

https://arctichealth.org/en/permalink/ahliterature157941
Source
Hum Vaccin. 2008 May-Jun;4(3):238-45
Publication Type
Article
Author
Marc Brisson
James M Pellissier
Stéphanie Camden
Caroline Quach
Philippe De Wals
Author Affiliation
Département de médecine sociale et préventive, Université Laval, Québec, Canada. marc.brisson@uresp.ulaval.ca
Source
Hum Vaccin. 2008 May-Jun;4(3):238-45
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Canada - epidemiology
Cost-Benefit Analysis
Female
Herpes Zoster - economics - epidemiology - prevention & control
Herpes Zoster Vaccine - economics - immunology
Herpesvirus 3, Human - immunology
Humans
Male
Middle Aged
Neuralgia, Postherpetic - economics - epidemiology - prevention & control
Quality-Adjusted Life Years
Vaccination - economics
Abstract
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.
PubMed ID
18382137 View in PubMed
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Vaccinating adolescents against meningococcal disease in Canada: a cost-effectiveness analysis.

https://arctichealth.org/en/permalink/ahliterature163092
Source
Vaccine. 2007 Jul 20;25(29):5433-40
Publication Type
Article
Date
Jul-20-2007
Author
Philippe De Wals
Laurent Coudeville
Pierre Trottier
Catherine Chevat
Lonny J Erickson
Van Hung Nguyen
Author Affiliation
Department of Preventive and Social Medicine, Laval University, Quebec City, Canada. Philippe.De.Wals@sss.gouv.qc.ca
Source
Vaccine. 2007 Jul 20;25(29):5433-40
Date
Jul-20-2007
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Canada - epidemiology
Child
Child, Preschool
Cost-Benefit Analysis
Humans
Immunization, Secondary - economics
Infant
Meningococcal Infections - economics - epidemiology - prevention & control
Meningococcal Vaccines - economics
Middle Aged
Abstract
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.
PubMed ID
17560695 View in PubMed
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10 records – page 1 of 1.