THE COST-EFFECTIVENESS OF PNEUMOCOCCAL VACCINATION STRATEGIES

Pneumonia and influenza, combined, are the sixth leading causes of dea th in the US. The age-adjusted mortality rate for these diseases incre ased by 20% between 1979 and 1993, perhaps as a result of the emergenc e of multi-drug-resistant and penicillin-resistant strains of bacteria that cause pneumonia. Of the approximately $US23 billion annual cost of community-acquired pneumonia, pneumococcal pneumonia is currently e stimated to account for up to $US18 billion. Considering the clinical and economic consequences of pneumococcal disease, vaccination appears to be a valuable preventive strategy. However, despite Medicare cover age and the recommendations of the Advisory Committee on Immunisation Practices (ACIP), only 28% of elderly and high-risk patients received the pneumococcal vaccine in 1993. This article reviews the epidemiolog y and economic factors that determine the cost effectiveness of pneumo coccal vaccination strategies. The strategies are taken from a review of 10 published economic analyses of the pneumococcal vaccine. Cost sa vings and favourable cost-effectiveness ratios are associated with key factors that increase vaccination programme benefits by maximising av erted direct medical costs as well as reducing vaccination programme c osts, such as through public vaccination campaigns.