Childhood vaccination against pneumococcal otitis media and pneumonia: An analysis of benefits and costs

Objective: To examine the economic benefits and costs of routine vaccinatio n of children younger than 5 years of age against pneumococcal otitis media and pneumonia with the pneumococcal conjugate vaccine. Study Design: A decision-analytic model of the cumulative numbers of cases and costs to age 10 years of acute otitis media (AOM), tympanostomy and rel ated procedures (TRP), and community-acquired pneumonia (CAP) in children w ho either did or did not receive the pneumococcal conjugate vaccine. Patients and Methods: Seven hypothetical cohorts of 1000 children, stratifi ed by age at initial vaccination, were followed. Outcome measures include c osts of vaccination, cumulative numbers of cases of AOM, TRP, and CAP to ag e 10 years, and related disease costs, including medical treatment and pare ntal work loss. Results: Routine vaccination of 1000 children against pneumococcal infectio n would cost between $57,000 and $226,000, depending on age (the recommende d number of doses varies by age at initial vaccination). Acute otitis media , TRP, and CAP to age 10 years would decline by 139 to 330, 8 to 22, and 15 to 30 cases, respectively; costs of medical treatment and work loss would correspondingly decline by $56,000 to $138,000. Expected net economic benef its (benefits minus costs) of vaccination against pneumococcal otitis media and pneumonia range from -$88,000 to $15,000 for children less than 2 year s of age, and from -$1,000 to $31,000 for those aged 2 to 5 years at vaccin ation. Conclusion: Routine vaccination against pneumococcal otitis media and pneum onia appears to be cost-increasing for children less than 2 years of age wh o require multiple doses, but cost-saving for children aged 2 to 5 years wh o would require only a single dose of the vaccine.