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Letters
July 26, 2000

Cost-effectiveness of Pneumococcal Vaccine

Author Affiliations
 

Stephen J.LurieMD, PhD, Contributing EditorIndividualAuthor

JAMA. 2000;284(4):440-441. doi:10.1001/jama.284.4.436

To the Editor: Dr Lieu and colleagues1 used pneumococcal vaccine efficacy estimates of 7%, 19%, and 20% for the prevention of simple otitis media (OM), complex OM, and OM requiring tympanostomy tube placement, respectively. These estimates are extrapolations of the vaccine efficacy against OM when the vaccine was given to infants in a 4-dose series as conducted in the Northern California Kaiser Permanente trial.2 Although the conjugate vaccine is immunogenic in older children, I question the validity of using the same efficacy data to calculate the cost-effectiveness of a single "catch-up" dose in older children.

Cost-effectiveness analyses should also take into consideration assumptions such as the natural history of the disease and the variation in medical practice settings. The decrease in the incidence of OM in older children compared with infants and toddlers, the fact that 80% of cases of OM can improve without antibiotics,3 and new shorter courses of treatment can significantly affect cost-analysis equations.

Parents and practitioners would welcome any measure that reduces the incidence of OM and decreases the use of antibiotics. I suspect that the demand for the conjugate pneumococcal vaccine could be high if it were promoted as "the OM vaccine for children attending day care." However, in an era of competing health care priorities, promotion of the use of this expensive vaccine without solid data in older children may not be the most cost-effective strategy.

References
1.
Lieu  TARay  GTBlack  SB  et al.  Projected cost-effectiveness of pneumococcal conjugate vaccination of healthy infants and young children.  JAMA. 2000;283:1460-1468.Google Scholar
2.
Black  SBShienefield  HRFireman  BH  et al.  Efficacy, safety, and immunogenicity of heptavalent pneumococcal conjugate vaccine (Wyeth) in children.  Pediatr Infect Dis J. 2000;19:187-195.Google Scholar
3.
Rosenfeld  RM What to expect from medical treatment of otitis media.  Pediatr Infect Dis J. 1995;14:731-738.Google Scholar
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