This study assessed the costs and benefits of introducing routine varicella vaccination to healthy children in Germany. Three vaccination strategies were compared with that of no prevention: vaccination of all 15-month-old children: vaccination of susceptible 12-year-olds (adolescent); and a combination of strategies (children including catch-up). From a purely economic viewpoint, the adeolescent strategy was optimal: It was the only one that resulted in net direct cost savings. However, since this strategy may be less acceptable from a medical or organizational point of view and because total net savings were the highest, a second option was to begin immunization starting with the 15-month-old children and to use the catch-up strategy for 11 years (total benefit-to-cost ratio (BCR), 4.72:1; cost-effectiveness ratio (CER), DM 6915 per life-year saved) and from year 12 on to use the first strategy (BCR, 4.60:1; CER, DM 19,735 per life-year saved).
Hepatitis A virus (HAV) infection is a substantial risk for travellers from low endemic countries to high endemic destinations. Costs and effects of alternative options for prevention were compared using formal decision analysis. General indications for the optimal prevention of hepatitis A were derived from a cost-effectiveness analysis. Various possible strategies for prevention of hepatitis A in travellers were compared to doing nothing: active immunisation using either the existing vaccine (HAVRIX 720) or the new vaccine (HAVRIX 1440); first screening for the presence of HAV antibodies and then vaccinating only susceptibles; and passive immunisation with immunoglobulin. Using a number of assumptions as baseline and for an average duration and frequency of travel from low to high endemic countries, threshold values were obtained for the choice between passive and active immunisation. Passive immunisation remains the most cost-effective prevention strategy for those expected to travel not more frequently than twice over the next 10 years and for short stays (7,000-9,000 pounds per infection prevented). For travellers expected to travel three or more times in 10 years or for trips exceeding a period of 6 months, active immunisation before the first trip is the most cost-effective option (7,500 pounds or less per infection prevented). When travel frequency increases to once a year in the next 10 years, costs per infection prevented decrease to about 3,500 pounds. Screening for the presence of antibodies before vaccination is only justified for older travellers or those leaving from countries with moderate endemicity, i.e., with an average HAV prevalence of at least 30%.
The advent of new vaccines and the changing epidemiology of hepatitis A call for an update of the economic evaluation of costs and benefits associated with the various alternative preventative strategies. A decision-tree-based model has been developed which enables the calculation of expected costs and expected numbers of hepatitis A virus HAV infections based on different intervention strategies. The model is sufficiently generic to allow for the evaluation of both population-wide strategies and strategies targeted at particular risk groups. An economic analysis focusing on travellers from Europe to high-endemic countries compared a non-intervention strategy to the following three strategies: active immunization with HAV vaccine; screening for HAV antibodies and vaccinating only susceptibles; passive immunization by means of immunoglobulin. The net cost per HAV infection prevented proved very sensitive to a number of important input parameters of the model. These included epidemiological characteristics such as HAV attack rate and prevalence of immunity, behavioural characteristics such as compliance with the vaccination scheme and vaccine characteristics such as rate and duration of protection. Our estimated expected cost per HAV infection prevented among Belgian travellers to high-endemic countries for three weeks per year over ten years amounts to approximately US$4880 for active immunization, US$5621 for screening followed by vaccination of susceptibles and US$29932 for passive immunization. Although these estimates are clearly sensitive to a number of crucial assumptions pertaining to the input parameters of the model, it seems safe to conclude that vaccination is more cost-effective than the currently recommended passive immunization with immunoglobulin.(ABSTRACT TRUNCATED AT 250 WORDS)
In our simulations, the most cost-effective pertussis prevention strategy was the use of an effective whole-cell vaccine with a high coverage rate. Introduction of the more expensive acellular pertussis vaccines becomes cost saving if at least a 7.5% increase in coverage is achieved. If also non-medical indirect costs to parents resulting from vaccine associated side-effects are accounted for, acellular vaccines may be more cost-effective also in countries with already high whole-cell vaccine coverage.
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