Abstract
BackgroundWhen vaccines increase longevity, vaccinated people may experience costs and benefits during added life-years. These future benefits and costs may include increased productivity as well as medical and non-medical costs. Such impacts should be considered in cost-effectiveness analyses (CEA) of vaccines but are often omitted. Here, we illustrate the impact of including future costs on the cost-effectiveness of vaccination against pneumococcus disease. We emphasize the relevance of differentiating cost estimates between risk groups. MethodsWe updated an existing Dutch CEA of vaccination against pneumococcus disease with the 13-valent pneumococcal conjugate vaccine (PCV13) to include all future medical and non-medical costs. We linked costs by age and risk with survival information and estimates of cases prevented per vaccination strategy based on the original study to calculate the impact of inclusion. Future medical costs were adjusted for relevant risk groups. ResultsFor the base-case strategy, the original incremental cost-effectiveness ratio (ICER) of PVC13 was €9,157 per quality adjusted life-year (QALY). Including all future medical costs increased the ICER to €28,540 per QALY. Also including future non-medical costs resulted in an ICER of €45,691 per QALY. The impact of future medical costs varied considerably per risk group and generally increased with age. Discussion and conclusionThis study showed a substantial effect of the inclusion of future costs on the ICER of vaccinating with PCV13. Especially when lives of people with underlying health conditions are extended, the impact of future medical costs is large. This inclusion may make vaccination a less attractive option, especially in relation to low thresholds as often applied for prevention. Although this raises important questions, ignoring these real future costs may lead to an inefficient use of healthcare resources. Our results may imply that prices for some vaccines need to be lowered to be cost-effective.
Highlights
When vaccines increase longevity, vaccinated people may experience costs and benefits during added life-years
The health benefits are typically quantified in quality adjusted life-years (QALYs) and the results summarized in an incremental cost-effectiveness ratio (ICER), the ratio of additional costs to additional benefits [2]
Decedents costs in the high-risk group show a hump-shaped pattern, for which an important factor is the large share of costs for cancers for this risk group, for which per capita costs increase until approximately age 60 and decrease
Summary
When vaccines increase longevity, vaccinated people may experience costs and benefits during added life-years. These future benefits and costs may include increased productivity as well as medical and non-medical costs Such impacts should be considered in cost-effectiveness analyses (CEA) of vaccines but are often omitted. Results: For the base-case strategy, the original incremental cost-effectiveness ratio (ICER) of PVC13 was €9,157 per quality adjusted life-year (QALY). When lives of people with underlying health conditions are extended, the impact of future medical costs is large This inclusion may make vaccination a less attractive option, especially in relation to low thresholds as often applied for prevention. The health benefits are typically quantified in quality adjusted life-years (QALYs) and the results summarized in an incremental cost-effectiveness ratio (ICER), the ratio of additional costs to additional benefits [2]. When a healthcare perspective is applied, all costs and benefits within the healthcare system should be considered, whereas for a broader societal perspective all costs and benefits for society are relevant [2]
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