Published online January 3, 2008
PEDIATRICS Vol. 121 Supplement January 2008, pp. S63-S78 (doi:10.1542/peds.2007-1115H)
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SUPPLEMENT ARTICLE


Projected Cost-effectiveness of New Vaccines for Adolescents in the United States

Ismael R. Ortega-Sanchez, PhDa, Grace M. Lee, MDb,c, R. Jake Jacobs, MSd, Lisa A. Prosser, PhDb, Noelle-Angelique Molinari, PhDa, Xinzhi Zhang, PhDe, William B. Baine, MDf, Mary M. McCauley, MTSCa, Ted Miller, PhDg for the Working Group on Leading Economic Issues for New Vaccine for Adolescents

a National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
b Center for Child Health Care Studies, Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard Medical School, Boston, Massachusetts
c Division of Infectious Diseases, Children's Hospital Boston, Boston, Massachusetts
d Capitol Outcomes Research, Inc, Alexandria, Virginia
e National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
f Center for Outcomes and Evidence, Agency for Healthcare Research and Quality, Department of Health and Human Services, Rockville, Maryland
g Pacific Institute for Research and Evaluation, Calverton, Maryland

BACKGROUND. Economic assessments that guide policy making on immunizations are becoming increasingly important in light of new and anticipated vaccines for adolescents. However, important considerations that limit the utility of these assessments, such as the diversity of approaches used, are often overlooked and should be better understood.

OBJECTIVE. Our goal was to examine economic studies of adolescent vaccines and compare cost-effectiveness outcomes among studies on a particular vaccine, across adolescent vaccines, and between new adolescent vaccines versus vaccines that are recommended for young children.

METHODS. A systematic review of economic studies on immunizations for adolescents was conducted. Studies were identified by searching the Medline, Embase, and EconLit databases. Each study was reviewed for appropriateness of model design, baseline setup, sensitivity analyses, and input variables (ie, epidemiologic, clinical, cost, and quality-of-life impact). For comparison, the cost-effectiveness outcomes reported in key studies on vaccines for younger children were selected.

RESULTS. Vaccines for healthy adolescents were consistently found to be more costly than the health care or societal cost savings they produced and, in general, were less cost-effective than vaccines for younger children. Among the new vaccines, pertussis and human papillomavirus vaccines were more cost-effective than meningococcal vaccines. Including herd-immunity benefits in studies significantly improved the cost-effectiveness estimates for new vaccines. Differences in measurements or assumptions limited further comparisons.

CONCLUSION. Although using the new adolescent vaccines is unlikely to be cost-saving, vaccination programs will result in sizable health benefits.

Key Words: cost-effectiveness • adolescents • vaccines

Abbreviations: HPV—human papillomavirus • LYS—life-years saved • QALY—quality-adjusted life-year • MPV4—meningococcal polysaccharide vaccine • MCV4—meningococcal conjugate vaccine • TdaP—tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis

Accepted Aug 22, 2007.




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[Abstract] [Full Text] [PDF]