Abstract
BackgroundEarlier cost-effectiveness studies showed the cost-effectiveness ratios for pneumococcal vaccination in preventing cases of Bacteremic Pneumococcal Disease (BPD) alone to vary between € 11,000 and € 33,000 per quality-adjusted life year. If vaccination is also assumed to be effective in preventing cases of Non Bacteremic Pneumococcal Disease (NBPD) (at the same level of effectiveness), vaccinating all elderly persons becomes highly cost-effective or even cost saving.MethodsThe present article examines the effect of partial preventive power of the vaccine against cases of NBPD additional to its preventive power against cases of BPD, and the consequences this has in terms of cost-effectiveness.ResultsThe analysis shows that even a fairly small additional preventive power against cases of NBPD leads to a dramatic and unexpected decrease in the cost-effectiveness ratio.ConclusionBecause a Cost-Effectiveness Ratio (CER) is a ratio, changes in costs and changes in effects have rather different influences on its value. There is a linear relation between a change in costs and a change in CER if the effects are kept constant. This linear relation is not found on the effect side. Assuming that costs are constant, a change in effect will be different for low levels of effect than for high levels.
Highlights
Data on efficacy or effectiveness are often among the cornerstones of the calculations of Cost-Effectiveness Ratios (CERs) and information on such effect variables is crucial for the decision-making process [1,2].As an example, this article considers the lack of information regarding the effectiveness of the vaccine for pneumococcal pneumonia
In an earlier short article [15], we discussed the results of an additional partial effectiveness of the vaccine against cases of Non Bacteremic Pneumococcal Disease (NBPD), and attributed the unexpected results we found merely to the fact that there are far more cases of NBPD than of Bacteremic Pneumococcal Disease (BPD)
In the step, where the vaccine is assumed to prevent an additional 10% of potential cases of NBPD, the CER drops to a level of about € 4,000
Summary
Data on efficacy or effectiveness are often among the cornerstones of the calculations of Cost-Effectiveness Ratios (CERs) and information on such effect variables is crucial for the decision-making process [1,2].As an example, this article considers the lack of information regarding the effectiveness of the vaccine for pneumococcal pneumonia. The assumption was made that the vaccine was able to prevent cases of NBPD to the same degree as it prevents cases of BPD. Earlier cost-effectiveness studies showed the cost-effectiveness ratios for pneumococcal vaccination in preventing cases of Bacteremic Pneumococcal Disease (BPD) alone to vary between € 11,000 and € 33,000 per quality-adjusted life year. If vaccination is assumed to be effective in preventing cases of Non Bacteremic Pneumococcal Disease (NBPD) (at the same level of effectiveness), vaccinating all elderly persons becomes highly cost-effective or even cost saving. In the base case analyses, the cost-effectiveness ratios for pneumococcal vaccination in preventing cases of BPD alone vary between € 11,000 and € 33,000 per QALY among the five countries. If vaccination is assumed to be effective in preventing cases of NBPD (at the same level of effectiveness), vaccinating all elderly persons would be highly cost-effective or even cost saving.
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