Retrospective economic evaluation of childhood 7-valent pneumococcal conjugate vaccination in Australia: Uncertain herd impact on XXXX critical.

@entity1485 @entity3 @entity55
BACKGROUND: Retrospective cost-effectiveness analyses of vaccination programs using routinely collected post-implementation data are sparse by comparison with pre-program analyses. We performed a retrospective economic evaluation of the childhood 7-valent pneumococcal conjugate vaccine (PCV7) program in Australia. METHODS: We developed a deterministic multi-compartment model that describes health states related to invasive and non- @entity3 . Costs (Australian dollars, A ) and health effects (quality-adjusted life years, QALYs) were attached to model states. The perspective for costs was that of the healthcare system and government. Where possible, we used observed changes in the disease rates from national surveillance and healthcare databases to estimate the impact of the PCV7 program (2005-2010). We stratified our cost-effectiveness results into alternative scenarios which differed by the outcome states included. Parameter uncertainty was explored using probabilistic sensitivity analysis. RESULTS: The PCV7 program was estimated to have prevented    5900 hospitalisations and    160 deaths from @entity3 ( @entity3 ). Approximately half of these were prevented in adults via herd protection. The incremental cost-effectiveness ratio was    A 161,000 per QALY gained when including only @entity3 -related outcomes. The cost-effectiveness of PCV7 remained in the range A 88,000- 122,000 when changes in various non-invasive disease states were included. The inclusion of observed changes in adult non-invasive @entity55 deaths substantially improved cost-effectiveness (   A 9000 per QALY gained). CONCLUSION: Using the initial vaccine price negotiated for Australia, the PCV7 program was unlikely to have been cost-effective (at conventional thresholds) unless observed reductions in non-invasive @entity55 deaths in the elderly are attributed to it. Further analyses are required to explore this finding, which has significant implications for the incremental benefit achievable by adult @entity1485 programs.
