Abstract
ABSTRACT Productivity benefits of health technologies are ignored in typical economic evaluations from a health payer’s perspective, risking undervaluation. We conduct a productivity-based cost-benefit analysis from a societal perspective and estimate indirect costs of adult pneumococcal disease, vaccination benefits from the adult 13-valent pneumococcal conjugate vaccine (PCV13 Adult), and rates of return to PCV13 Adult for a range of hypothetical vaccination costs. Our context is Turkey’s funding PCV13 for the elderly and for non-elderly adults with select comorbidities within the Ministry of Health’s National Immunization Program. We use a Markov model with one-year cycles. Indirect costs from death or disability equal the expected present discounted value of lifetime losses in the infected individual’s paid and unpaid work and in caregivers’ paid work. Vaccination benefits comprise averted indirect costs. Rates of return equal vaccination benefits divided by vaccination costs, minus one. Input parameters are from public data sources. We model comorbidities’ effects by scalar multiplication of the parameters of the general population. Indirect costs per treatment episode of inpatient community-acquired pneumonia (CAP), bacteremia, and meningitis – but not for outpatient CAP – approach or exceed Turkish per capita gross domestic product. Vaccination benefits equal $207.02 per vaccination in 2017 US dollars. The rate of return is positive for all hypothetical costs below this. Results are sensitive to herd effects from pediatric vaccination and vaccine efficacy rates. For a wide range of hypothetical vaccination costs, the rate of return compares favorably with those of other global development interventions with well-established strong investment cases.
Highlights
Vaccination is among the most impactful public health interventions of our age.[1]
We construct parameters for the comorbid subpopulation by scaling parameter values that apply to Turkey’s general population to account for the impact of comorbidities on those parameter values. This involves scaling up non-pneumococcal disease (PD)-related mortality rates, incidence rates, and parameters related to length of hospital stay for inpatient and outpatient community-acquired pneumonia (CAP)
We discount costs and benefits at a rate of 3% annually, which is typical in the economic evaluation literature, and has been recommended by the Second Panel[2] and used in a prior evaluation of PPV23 Adult in Turkey by Akin et al (2011).[16]
Summary
Vaccination is among the most impactful public health interventions of our age.[1]. innovation has multiplied the number of health technologies competing for reimbursement from a health payer’s ( “payer”) budget. We derive vaccine efficacy from the Community-Acquired Pneumonia Immunization Trial in Adults (CAPITA) study.[13] We let baseline vaccine efficacy (i.e., initial vaccine efficacy, before waning) decline with age among those aged 50 and up in order to account for immunosenescence following the van Werkhoven et al (2014)[42] Cox-proportional hazardbased analysis of CAPITA study results. Prevalence rates of comorbidities come from Turkish data sources.[57,58,59,60,61,62] We construct parameters for the comorbid subpopulation by scaling parameter values that apply to Turkey’s general population to account for the impact of comorbidities on those parameter values This involves scaling up non-PD-related mortality rates, incidence rates, and parameters related to length of hospital stay for inpatient and outpatient CAP (days before full productivity is reached for temporary disability, the hours per month of long-term care, and days of short-term care needed).
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