Projected cost-effectiveness of pneumococcal conjugate vaccination of healthy infants and young children

Context Pneumococcal conjugate vaccine for infants has recently been found effective against meningitis, bacteremia, pneumonia, and otitis media. Objective Tc,evaluate the projected health and economic impact: of pneumoco ccal conjugate vaccination of healthy US infants and young children. Design Cost-effectiveness analysis based on data from the Northern Californ ia Kaiser Permanente randomized trial and other published and unpublished s ources. Setting and Patients A hypothetical US birth cohort of 3.8 million infants, Interventions Hypothetical comparisons of routine vaccination of healthy in fants, 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 re quiring 1 dose, with children receiving no intervention. Main Outcome Measures Cost per life-year saved and cost per-episode of meni ngitis, 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 episode s of otitis media, and 116 deaths due to pneumococcal infection. Before acc ounting for vaccine costs, the vaccination program would save $342 million in medical and $415 million in work-loss and other costs from averted pneum ococcal disease. Vaccination of healthy infants would result in net savings for society if the vaccine cost less than $46 per dose, and net savings fo r the health care payer if the vaccine cost less than $18 pet dose. At the manufacturer's list price of $58 per dose, infant vaccination would cost so ciety $80 000 per life-year saved or $160 per otitis media episode prevente d (other estimated costs would be $3200 per pneumonia case prevented, $15 0 00 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 p neumococcal disease, and vaccine cost Conclusions Pneumococcal conjugate vaccination of healthy US infants has th e potential to be cost-effective, To achieve cost savings, its cost would n eed 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.