Preferences and Willingness to Pay for Health States Prevented by Pneumococcal Conjugate Vaccine
,¶
* Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts
Center for Child Health Care Studies, Harvard Pilgrim Health Care, Boston, Massachusetts
Division of Research, Kaiser Permanente, Oakland, California
|| National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia
¶ Division of General Pediatrics, Children’s Hospital, Boston, Massachusetts
Objective. To measure parents’ and other adults’ values for preventing disease associated with pneumococcal infection and to evaluate how including these values changes the economic appraisal of pneumococcal conjugate vaccine.
Methods. Data on preferences and willingness to pay to reduce risk of illness were collected for 6 illnesses that are preventable by pneumococcal conjugate vaccine (simple otitis media, complex otitis media, moderate pneumonia, severe pneumonia, bacteremia, and meningitis) and 1 vaccine-related adverse event (fever and fussiness after vaccine). Interviews were conducted with 2 groups of respondents: 1) parents of children who had experienced 1 or more of the outcomes described in the survey (n = 101) and 2) a US community sample (n = 109). The 30-minute telephone interview used modified time trade-off questions and willingness-to-pay questions. Values from the interview were incorporated in an existing decision-analytic model that simulated the cost-effectiveness and cost-benefit of pneumococcal conjugate vaccine in a hypothetical cohort of newborns.
Results. Among parents, the median amount of time that respondents said that they would be willing to trade to avoid diseases ranged from 0 days for otitis media to 1 year for severe pneumonia and 2 years for meningitis. Among the US community sample, the median amounts of time traded were higher, ranging from 7 days for otitis media to 3 years for meningitis. Median willingness-to-pay amounts varied from $100 to prevent 1 episode of otitis media and $500 to reduce the risk of meningitis from 21 in 100 000 to 6 in 100 000 and were similar between parents and community members. Incorporating time trade-off amounts into the existing economic model for pneumococcal conjugate vaccine resulted in cost-effectiveness ratios <$10 000 per quality-adjusted life year at a vaccine cost of $58 per dose.
Conclusions. Both parents and community members assign relatively high values to preventing meningitis, pneumonia, and complex otitis media. When the value of preventing pneumococcal diseases is incorporated into economic analyses, pneumococcal conjugate vaccine has a cost-effectiveness ratio in the range of other widely used health interventions.
Key Words: preferences • utilities • willingness-to-pay • pneumococcal conjugate vaccine
Abbreviations: QALY, quality-adjusted life-year
Received for publication Jan 29, 2003; Accepted May 14, 2003.
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eLetters:
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- Comments on Prosser et al's approach to value disease reduction in children
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