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Comparative cost effectiveness of varicella, hepatitis A, and pneumococcal conjugate vaccines
1Capitol Outcomes Research, Inc., Alexandria, Virginia 22310, USA. Jacobs@CapitolOutcomesResearch.com
Insights
Hepatitis A and varicella vaccines are cost-effective for school entry. Pneumococcal conjugate vaccine is less cost-effective, despite potential societal cost reductions from varicella vaccination.
Area of Science:
- Public Health
- Health Economics
- Vaccinology
Background:
- U.S. governments consider vaccine mandates for day care and school entry.
- Sequential mandates are preferred over simultaneous ones to manage costs and communication.
- Standardizing cost-effectiveness methods is crucial for prioritizing vaccinations.
Purpose of the Study:
- To conduct a standardized cost-effectiveness analysis of childhood varicella, hepatitis A, and pneumococcal conjugate vaccines.
- To inform vaccination priority setting for school and day care entry requirements.
Main Methods:
- Reviewed U.S. cost-effectiveness studies of childhood vaccines.
- Standardized methods using original study data and current prices for costs.
- Estimated life-years saved using original data, epidemiological evidence, and discounting procedures.
Main Results:
- Hepatitis A vaccine demonstrated the lowest health system cost per life-year saved.
- Varicella vaccine offered the greatest societal cost reduction, primarily via reduced parent work loss.
- Pneumococcal conjugate vaccine was less cost-effective and more expensive than the other two vaccines combined.
Conclusions:
- Hepatitis A and varicella vaccines meet conventional cost-effectiveness standards for school entry.
- Pneumococcal conjugate vaccine does not meet conventional cost-effectiveness standards.
- Findings support prioritizing hepatitis A and varicella vaccines for mandates.
Background:
Several state and local U.S. governments are considering making varicella, hepatitis A, and/or pneumococcal conjugate vaccination conditions of day care or school entry. These requirements will likely be issued sequentially, because simultaneous mandates exacerbate budget constraints and complicate communication with parents and providers. Cost-effectiveness assessments should aid the establishment of vaccination priorities, but comparing results of published studies is confounded by their dissimilar methods.
Methods:
We reviewed U.S. cost-effectiveness studies of childhood varicella, hepatitis A, and pneumococcal conjugate vaccines and identified four providing data required to standardize methods. Vaccination, disease treatment, and work-loss costs were estimated from original study results and current prices. Estimated life-years saved were derived from original study results, epidemiological evidence, and alternative procedures for discounting to present values.
Results:
Hepatitis A vaccine would have the lowest health system costs per life-year saved. Varicella vaccine would provide the greatest reduction in societal costs, mainly through reduced parent work loss. Pneumococcal conjugate vaccine would cost twice the amount of varicella and hepatitis A vaccines combined and be less cost effective than the other vaccines.
Conclusions:
Hepatitis A and varicella vaccines, but not pneumococcal conjugate vaccine, meet or exceed conventional standards of cost effectiveness.