Cost-Effectiveness Analysis of Pneumococcal Vaccination for Elderly Individuals in The Netherlands
Maarten J. Postma
Marielouise A. Heijnen
Johannes C. Jager
Objective: To assess the cost effectiveness (net costs per life year gained) of pneumococcal vaccination of elderly individuals aged 65 years and over in The Netherlands. Design and setting: A pharmacoeconomic analysis was conducted from the healthcare perspective in The Netherlands. The gender- and age-specific modelling framework linked epidemiological aspects of invasive pneumococcal disease (e.g. incidence, mortality, life years lost) to vaccination and hospital resource use. To derive 90% confidence limits for net costs per life year gained a stochastic analysis was performed. Intervention: Pneumococcal vaccination in the elderly with the 23-valent vaccine. Effectiveness of the vaccine in preventing invasive pneumococcal disease was derived from international studies. Main outcome measures and results: Pneumococcal vaccination in the elderly was not found to be cost saving. At baseline, stochastic and univariate sensitivity analysis net costs per life year gained were estimated to be between 6000 and 16 000 euro (EUR) [EUR1 = 1.1 US dollars; cost level 1995]. A scenario analysis on alternative age-dependent vaccination strategies indicated even higher net costs per life year gained, up to EUR28 000 for vaccinating only those elderly aged 85 years and over. Conclusions: Pneumococcal vaccination is associated with net costs per life year gained of EUR10 100 (at baseline assumptions). These costs are higher than those for influenza vaccination (EUR5500). Our pharmacoeconomic approach, which needs to be considered in conjunction with social, psychological and budgetary issues, is intended to contribute to rational decision-making in healthcare policy.
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