Author Affiliations: Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard Medical School, Boston, Mass (Dr Lieu); Division of Research (Dr Lieu and Mr Ray), Vaccine Study Center (Drs Black and Shinefield), Kaiser Permanente, Oakland, Calif; Department of Pediatrics, Boston City Hospital, Boston University Medical Center, Boston, Mass (Dr Klein); Artic Investigations Program, National Center for Infectious Diseases, Anchorage, Alaska (Dr Butler) and National Vaccine Program Office (Dr Breiman), Centers for Disease Control and Prevention, Atlanta, Ga; and Children's Vaccine Initiative, Geneva, Switzerland (Dr Miller).
Context Pneumococcal conjugate vaccine for infants has recently been found effective
against meningitis, bacteremia, pneumonia, and otitis media.
Objective To evaluate the projected health and economic impact of pneumococcal
conjugate vaccination of healthy US infants and young children.
Design Cost-effectiveness analysis based on data from the Northern California
Kaiser Permanente randomized trial and other published and unpublished sources.
Setting and Patients A hypothetical US birth cohort of 3.8 million infants.
Interventions Hypothetical comparisons of routine vaccination of healthy infants,
requiring 4 doses of pneumococcal conjugate vaccine (at 2, 4, 6, and 12-15
months), and catch-up vaccination of children aged 2 to 4.9 years requiring
1 dose, with children receiving no intervention.
Main Outcome Measures Cost per life-year saved and cost per episode of meningitis, bacteremia,
pneumonia, and otitis media prevented.
Results Vaccination of healthy infants would prevent more than 12,000 cases
of meningitis and bacteremia, 53,000 cases of pneumonia, 1 million episodes
of otitis media, and 116 deaths due to pneumococcal infection. Before accounting
for vaccine costs, the vaccination program would save $342 million in medical
and $415 million in work-loss and other costs from averted pneumococcal disease.
Vaccination of healthy infants would result in net savings for society if
the vaccine cost less than $46 per dose, and net savings for the health care
payer if the vaccine cost less than $18 per dose. At the manufacturer's list
price of $58 per dose, infant vaccination would cost society $80,000 per life-year
saved or $160 per otitis media episode prevented (other estimated costs would
be $3200 per pneumonia case prevented, $15,000 for bacteremia, and $280,000
for meningitis). The cost-effectiveness of an additional program to administer
1 dose of vaccine to children aged 2 to 4.9 years would vary depending on
the children's ages, relative risks of pneumococcal disease, and vaccine cost.
Conclusions Pneumococcal conjugate vaccination of healthy US infants has the potential
to be cost-effective. To achieve cost savings, its cost would need to be lower
than the manufacturer's list price. In addition to tangible costs, the vaccine
should be appraised based on the less tangible value of preventing mortality
and morbidity from pneumococcal disease.
Lieu TA, Ray GT, Black SB, et al. Projected Cost-effectiveness of Pneumococcal Conjugate Vaccination of Healthy Infants and Young Children. JAMA. 2000;283(11):1460–1468. doi:10.1001/jama.283.11.1460
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