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Policymaking based on CERs: changes in costs are not the same as changes in benefits
Andre Jha Ament1, Silvia Mma Evers
1Department of Health Organization, Policy and Economics, University of Maastricht, Maastricht, the Netherlands. a.ament@beoz.unimaas.nl.
Cost Effectiveness and Resource Allocation : C/E
|March 25, 2005
Summary
Pneumococcal vaccination is highly cost-effective for the elderly, especially when considering its impact on both Bacteremic Pneumococcal Disease (BPD) and Non Bacteremic Pneumococcal Disease (NBPD). Even partial effectiveness against NBPD significantly improves the cost-effectiveness ratio.
Area of Science:
- Public Health
- Health Economics
- Vaccinology
Background:
- Previous studies established cost-effectiveness ratios for pneumococcal vaccination against Bacteremic Pneumococcal Disease (BPD) ranging from $11,000 to $33,000 per quality-adjusted life year.
- Assuming vaccination prevents Non Bacteremic Pneumococcal Disease (NBPD) at similar effectiveness levels suggests high cost-effectiveness or cost savings for vaccinating all elderly individuals.
Purpose of the Study:
- To analyze the impact of partial vaccine effectiveness against NBPD, in addition to BPD, on cost-effectiveness.
- To evaluate the consequences of incorporating NBPD prevention into cost-effectiveness calculations for pneumococcal vaccination.
Main Methods:
- Examined the effect of partial preventive power against NBPD alongside established effectiveness against BPD.
- Assessed the resulting changes in cost-effectiveness ratios.
Main Results:
- A small increase in preventive effectiveness against NBPD led to a substantial and unanticipated reduction in the cost-effectiveness ratio.
- Demonstrated that changes in effects have a non-linear influence on the Cost-Effectiveness Ratio (CER), unlike changes in costs.
Conclusions:
- The Cost-Effectiveness Ratio (CER) is sensitive to the level of effect, with diminishing returns at higher effectiveness levels.
- Even modest additional preventive benefits against NBPD dramatically enhance the economic value of pneumococcal vaccination programs for the elderly.