Difference between revisions of "Economic evaluation"
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Are the incremental health effects worth the incremental costs, if a vaccine is both more effective and more expensive? | Are the incremental health effects worth the incremental costs, if a vaccine is both more effective and more expensive? | ||
*The health benefit of the national infant immunisation programme is assessed by the expected reduction in the annual number of invasive pneumococcal disease in the Finnish population. The health benefit or effectiveness is measured in Quality-Adjusted Life Years (QALYs). | *The health benefit of the national infant immunisation programme is assessed by the expected reduction in the annual number of invasive pneumococcal disease in the Finnish population. The health benefit or effectiveness is measured in Quality-Adjusted Life Years (QALYs). | ||
| − | *The perspective of this analysis is the health care provider. | + | *The perspective of this analysis is that of the health care provider. |
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<math>ICER = \frac{(C_2-S_2) - (C_1-S_1)}{E_2-E_1},</math> | <math>ICER = \frac{(C_2-S_2) - (C_1-S_1)}{E_2-E_1},</math> | ||
| − | where C is the | + | where C is the price of the vaccination program, S is the savings in health care costs and E is the savings in QALYs. |
| − | Each vaccine (ranked according to their effectiveness) is compared with the next highest ranked vaccine. The least effective vaccine is compared with doing nothing. The most cost-effective vaccine is chosen. | + | Each vaccine (ranked according to their effectiveness) is compared with the next highest ranked vaccine. The least effective vaccine is compared with doing nothing. The most cost-effective vaccine is chosen. <br> <text col="grey"> (Note: In general, a low ICER does not necessarily mean that the treatment should be implemented, since another more effective treatment with higher ICER that is below the willingness-to-pay threshold may exist. <ref>Karlsson, G. and Johannesson, M. 1996. The Decision Rules of Cost-Effectiveness Analysis. Pharmaeconomics 1996; 9(2): 113-120. </ref> However, in the comparison considered here, the most cost-effective vaccine is chosen.) |
| + | </text> | ||
=== A study from Latin America about the efficacy of Synflorox === | === A study from Latin America about the efficacy of Synflorox === | ||
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Contents
Question
Are the incremental health effects worth the incremental costs, if a vaccine is both more effective and more expensive?
- The health benefit of the national infant immunisation programme is assessed by the expected reduction in the annual number of invasive pneumococcal disease in the Finnish population. The health benefit or effectiveness is measured in Quality-Adjusted Life Years (QALYs).
- The perspective of this analysis is that of the health care provider.
Answer
To find the most cost-effective vaccine according to the crieria described in the rationale.
Rationale
Vaccines are ranked according to their effectiveness (V1 < V2 < V3, etc.). Vaccines that are more expensive and less effective compared with at least one other alternative (strongly dominated) are excluded. Incremental cost-effectiveness ratios (ICER) are calculated for the remaining vaccines:
Failed to parse (Missing <code>texvc</code> executable. Please see math/README to configure.): ICER = \frac{(C_2-S_2) - (C_1-S_1)}{E_2-E_1},
where C is the price of the vaccination program, S is the savings in health care costs and E is the savings in QALYs.
Each vaccine (ranked according to their effectiveness) is compared with the next highest ranked vaccine. The least effective vaccine is compared with doing nothing. The most cost-effective vaccine is chosen.
<text col="grey"> (Note: In general, a low ICER does not necessarily mean that the treatment should be implemented, since another more effective treatment with higher ICER that is below the willingness-to-pay threshold may exist. [1] However, in the comparison considered here, the most cost-effective vaccine is chosen.)
</text>
A study from Latin America about the efficacy of Synflorox
Background:
The relationship between pneumococcal conjugate vaccine–induced antibody responses and protection against community-acquired pneumonia (CAP) and acute otitis media (AOM) is unclear. This study assessed the impact of the ten-valent pneumococcal nontypable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) on these end points. The primary objective was to demonstrate vaccine efficacy (VE) in a per-protocol analysis against likely bacterial CAP (B-CAP: radiologically confirmed CAP with alveolar consolidation/pleural effusion on chest X-ray, or non-alveolar infiltrates and C-reactive protein 40 mg/ml); other protocol-specified outcomes were also assessed.[2]
Methods and Findings:
This phase III double-blind randomized controlled study was conducted between 28 June 2007 and 28 July 2011 in Argentine, Panamanian, and Colombian populations with good access to health care. Approximately 24,000 infants received PHiD-CV or hepatitis control vaccine (hepatitis B for primary vaccination, hepatitis A at booster) at 2, 4, 6, and 15–18 mo of age. Interim analysis of the primary end point was planned when 535 first B-CAP episodes, occurring 2 wk after dose 3, were identified in the per-protocol cohort. After a mean follow-up of 23 mo (PHiD-CV, n=10,295; control, n=10,201), per-protocol VE was 22.0% (95% CI: 7.7, 34.2; one-sided p=0.002) against B-CAP (conclusive for primary objective) and 25.7% (95% CI: 8.4%, 39.6%) against World Health Organization–defined consolidated CAP. Intent-to-treat VE was 18.2% (95% CI: 5.5%, 29.1%) against B-CAP and 23.4% (95% CI: 8.8%, 35.7%) against consolidated CAP. End-of-study per-protocol analyses were performed after a mean follow-up of 28–30 mo for CAP and invasive pneumococcal disease (IPD) (PHiD-CV, n=10,211; control, n=10,140) and AOM (n=3,010 and 2,979, respectively). Per-protocol VE was 16.1% (95% CI: 21.1%, 30.4%; one-sided p=0.032) against clinically confirmed AOM, 67.1% (95% CI: 17.0%, 86.9%) against vaccine serotype clinically confirmed AOM, 100% (95% CI: 74.3%, 100%) against vaccine serotype IPD, and 65.0% (95% CI: 11.1%, 86.2%) against any IPD. Results were consistent between intent-to-treat and per-protocol analyses. Serious adverse events were reported for 21.5% (95% CI: 20.7%, 22.2%) and 22.6% (95% CI: 21.9%, 23.4%) of PHiD-CV and control recipients, respectively. There were 19 deaths (n=11,798; 0.16%) in the PHiD-CV group and 26 deaths (n=11,799; 0.22%) in the control group. A significant study limitation was the lower than expected number of captured AOM cases.[2]
Editor's summary:
What Did the Researchers Do and Find?
The researchers enrolled around 24,000 infants living in urban areas of Argentina, Panama, and Colombia. Half the infants were given PHiD-CV at 2, 4, and 6 months of age and a booster dose at age 15–18 months. The remaining infants were given a hepatitis control vaccine at the same intervals. The trial’s primary end point was likely bacterial CAP (B-CAP) –radiologically confirmed CAP, with the airspaces (alveoli) in the lungs filled with liquid instead of gas (alveolar consolidation) or with nonalveolar infiltrates and raised blood levels of C-reactive protein (a marker of inflammation). In a planned interim analysis, which was undertaken after an average follow-up of 23 months, the vaccine efficacy in the per-protocol cohort (the group of participants who actually received their assigned intervention) was 22% against B-CAP. Intent-to-treat vaccine efficacy in the interim analysis (which considered all the trial participants regardless of whether they received their assigned intervention) was 18.2%. At the end of the study (average follow up 30 months), the vaccine efficacy against B-CAP was 18.2% and 16.7% in the per-protocol and intent-to-treat cohorts, respectively. Per-protocol vaccine efficacies against clinically confirmed AOM and vaccine serotype AOM were 16.1% and 67.1%, respectively. Against any IPD and against vaccine serotype IPD, the respective vaccine efficacies were 65% and 100%. Finally, about one-fifth of children who received PHiD-CV and a similar proportion who received the control vaccine experienced a serious adverse event (for example, gastroenteritis); 19 children who received PHiD-CV died compared to 26 children who received the control vaccine.[2]
What Do These Findings Mean?
These findings indicate that in Latin America, a region with an intermediate burden of pneumococcal disease, PHiD-CV is efficacious against a broad range of pneumococcal diseases that often affect young children. The accuracy of these findings may be limited by the withdrawal of 14% of participants from the trial because of adverse media coverage and by the low number of reported cases of AOM. Moreover, because most study participants lived in urban areas, these findings may not be generalizable to rural settings. Despite these and other study limitations, these findings provide new information about the magnitude of the effect of PHiD-CV vaccination against CAP andAOM,two mucosal pneumococcal diseases of global public health importance.[2]
See also
References
- ↑ Karlsson, G. and Johannesson, M. 1996. The Decision Rules of Cost-Effectiveness Analysis. Pharmaeconomics 1996; 9(2): 113-120.
- ↑ 2.0 2.1 2.2 2.3 Efficacy of Ten-Valent PHiD-CV in Children: Miguel W. Tregnaghi, Xavier Sáez-Llorens, Pio López, Hector Abate, Enrique Smith, Adriana Pósleman, Arlene Calvo, Digna Wong, Carlos Cortes-Barbosa, Ana Ceballos, Marcelo Tregnaghi, Alexandra Sierra, Mirna Rodriguez, Marisol Troitiño, Carlos Carabajal, Andrea Falaschi, Ana Leandro, Maria Mercedes Castrejón, Alejandro Lepetic, Patricia Lommel, William P. Hausdorff, Dorota Borys, Javier Ruiz Guiñazú, Eduardo Ortega-Barría, Juan P. Yarzábal, Lode Schuerman
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