Economic evaluation
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Contents
Question
How to identify the most cost-effective pneumococcal conjugate vaccine to the national immunisation programme?
- The health benefit (effectiveness) of the pneumococcal infant immunisation programme is assessed by the expected gain in Quality-Adjusted Life Years (QALYs), corresponding to the expected reduction in the annual number of invasive pneumococcal disease in the whole Finnish population.
- The perspective of the analysis is that of the health care provider.
- The analysis is based on incremental cost effectiveness
Answer
The answer to the question is based on the concept of incremental costs. For example, if there are only two vaccines to be compared, the more effective (and more expensive vaccine) is said to be more cost-effective if the incremental cost effectiveness ratio (ICER), comparing the vaccine to the less effective vaccine, exceeds the ICER of the less effective vaccine as compared to the alternative 'no vaccination'. The principle in general is explained below (see 'Rationale').
For an example of two vaccines, ICERs can be calculated with a programme code (see 'Rationale').
Rationale
Vaccination programmes are ranked in ascending order according to their effectiveness. The effectiveness is measured as the expected reduction in invasive pneumococcal disease, as predicted by the epidemiological model. Alternatives for which there is at least one other alternative with lower cost and better effectiveness are first excluded. Each programme ('A') is then compared to the next more effective programme ('B') by the incremental cost-effectiveness ratio (ICER):
Failed to parse (Missing <code>texvc</code> executable. Please see math/README to configure.): ICER = \frac{(C_B-S_B) - (C_A-S_A)}{E_B-E_A},
where C is the price of the vaccination program, S is the savings in health care costs (as compared to strategy 'no vaccination') and E is the savings in QALYs (as compared to 'no vaccination'). Any programme that is followed by a (more effective) programme with a smaller ICER (i.e. one which produces an additional unit of effect with lower cost) is dropped off from further consideration. The ICERs are then re-calculated and the procedure repeated as many times as needed to eventually identify the most cost-effective alternative.
Costs
Health care resource use in secondary health care per IPD case and sequelae after meningitis were estimated from Hospital Discharge Register (2000-2006). For each meningitis and bacteremia case, an episode of care was constructed by linking the outpatient visits and inpatient hospitalizations using the unique personal identity code. The case fatality ratio (CFR) for IPD was obtained from a Finnish study [Klemets P, Lyytikäinen O, Ruutu P, Ollgren J, Nuorti P. Incidence and outcome of invasive Streptococcus pneumonia infections, Finland, 1995 /2002. In: The 4th International Symposium on Pneumococci and Pneumococcal Diseases (ISPPD); 2004 May 9 /13 2004; Helsinki; 2004.]. The unit costs for hospitalizations and outpatient visits were estimated based on individual-level cost accounting data from one hospital district. Other unit cost estimates were mainly taken from a widely used national price list for the unit costs of health care in Finland. The costs were presented in 2012 prices and were evaluated from the health care provider perspective. The future costs and benefits were discounted at 3% per annum.
Sensitivity
The effects of alternative vaccine compositions on the outcomes of the cost-benefit analysis were assessed. Five modifications for PCV10 and one for PCV13 were considered Conclusion: The assumption about serotype 3 in PCV13 is crucial. In addition, assumptions about the role of 6A in PCV10 is important. For results, see Cost_effectiveness_sensitivity.
Calculations
The following code can be used to calculate the incremental cost effectiveness ratios (ICERs) for two alternative vaccination programmes. The following input is required:
(a) the serotype compositions of the two vaccines to be compared (the defaults are PCV10 and PCV13), and
(b) the prices per dose for the two vaccine products.
The computation utilises the epidemiological model to predict the annual number of invasive pneumococcal disease (IPD) under both vaccination programmes and, for comparison, for the scenario 'no vaccination'. The summary table presents the ICERs. The vaccine programme with the lower ICER is identified as the more cost-effective of the two alternatives.
Variable initiation (Only for developers)
Cost calculation (Only for developers)
Data (Only for developers)
See also
References
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