APPENDIX 1.

Health State Descriptions for Outcomes Prevented by Pneumococcal Conjugate Vaccine

1. Ear infection in a 1-year-old
 • Your 1-year-old child is fussy and has a fever of 101 for 1 day, requiring a visit to the pediatrician.
 • The pediatrician prescribes a common liquid antibiotic that needs to be taken 3 times a day for 10 days.
 • The symptoms of the ear infection subside in 24 hours.
 Risk reduction for willingness-to-pay question: From 4 episodes to 3 episodes before age 5.
2. Recurring ear infections in a 1-year-old
 • Your 1-year-old child is fussy and has a fever of 101 for 1 day, requiring a visit to the pediatrician.
 • The pediatrician prescribes a common liquid antibiotic that needs to be taken 3 times a day for 10 days.
 • The symptoms of the ear infection subside in 24 hours, but your child gets sick again 3 weeks later with fussiness and fever just like the first time.
 • You take your child back to the pediatrician, and another antibiotic is prescribed. This antibiotic is taken once a day for 7 days.
 • Three weeks later, your child gets sick for a third time with the same symptoms, and your child receives a third antibiotic. Frequent ear infections can interfere with sleep and regular activities.
 • Because your child has had frequent ear infections, there is a 30% chance that your child will receive ear tubes known as tympanostomy tubes to help prevent additional infections. Your child will need to be “put to sleep” under general anesthesia to have the tubes put in. General anesthesia carries some risks, including a risk of death (approximately 1 in 250 000). You will have to come to the hospital for 1 day for the procedure but will not have to stay overnight. The tubes usually stay in at least 1 year, then fall out on their own.
 Risk reduction for willingness-to-pay question: From 27 in 100 to 23 in 100 before age 5.
3. Moderate pneumonia in a 1-year-old
 • Your child has had a cough and fever for 2 days and requires a visit to the pediatrician. Your child is very tired and does not feel like participating in normal activities such as playing or going to school.
 • Blood tests and a chest X-ray are performed, showing that your child has pneumonia.
 • An oral antibiotic is prescribed. This needs to be taken once a day for 10 days.
 • Your child recovers within 10 days and experiences no additional problems.
 Risk reduction for willingness-to-pay question: From 13 in 1000 to 4 in 1000 before age 5.
4. Severe pneumonia in a 1-year-old
 • Your child has had a cough and fever for 2 days and requires a visit to the pediatrician. Your child is extremely tired, and does not feel like participating in normal activities such as playing or going to school. She or he is breathing a little fast and coughing so much that it interrupts the child’s activities and sleep.
 • Blood tests and a chest X-ray are performed, showing that your child has severe pneumonia.
 • Your child is hospitalized for intravenous antibiotics and oxygen for 4 days.
 • After leaving the hospital, the child recovers within another week and experiences no additional problems
 Risk reduction for willingness-to-pay question: From 7 in 1000 to 2 in 1000 before age 5.
5. Bacterial meningitis in a 1-year-old
 • Your 1-year-old child is very fussy and has a high fever (103 or more) for 1 or 2 days, requiring a visit to the pediatrician. He or she is also very lethargic (seems to have no energy or interest in anything but sleeping and resting).
 • The pediatrician performs a series of tests, including a spinal tap (a needle is inserted into your child’s spine to withdraw fluid for testing) and blood tests.
 • Your child is hospitalized for intravenous antibiotics for 10 days and after leaving the hospital experiences no additional problems.
 Risk reduction for willingness-to-pay question:
 • Reduce the risk of your child’s having pneumococcal meningitis from 21 in 100 000 to 6 in 100 000
 • This will also have the effect of reducing the risk of dying from pneumococcal meningitis from 11 in 1 million to 3 in 1 million.
 • This will also have the effect of reducing the risk of deafness from pneumococcal meningitis from 27 in 1 million to 8 in 1 million.
 • This will also have the effect of reducing the risk of permanent disability from pneumococcal meningitis from 14 in 1 million to 4 in 1 million.
6. Blood infection, or bacteremia, in a 1-year-old
 • Your child has been irritable and had a fever for several days. His or her fever then rises to 104, and you take him or her to the pediatrician.
 • The pediatrician performs blood tests and a chest X-ray.
 • Your child receives intramuscular antibiotics at the doctor’s office and a second dose the next day. An intramuscular injection is a little different from the shots your child usually receives—it is a deeper injection into the muscle tissue, usually given in the thigh.
 • Fever and symptoms resolve after 48 hours with this treatment.
 Risk reduction for willingness-to-pay question:
 • Reduce the risk of your child’s getting a blood infection from 39 in 10 000 to 11 in 10 000
 • This means that the risk of dying from a blood infection will be reduced from 30 in 1 million to 8 in 1 million
7. Fussiness and fever after vaccination in a 4-month-old
 • Your 4-month-old baby receives a vaccine at the doctor’s office in the afternoon.
 • That evening, the baby has a fever of 101. The infant also is fussy: he or she cries for long periods, refuses to play, and is difficult to comfort.
 • The baby is fine by the next afternoon.
8. New pneumococcal vaccine
 The vaccine’s protection lasts 5 years. Because most serious pneumococcal infections strike children during their first 2 years, the vaccine will protect them when they are at greatest risk. This new vaccine will provide the following benefits for your child from birth to age 5:
 • Expected number of ear infections will be reduced from 4 to 3.
 • The risk of recurrent ear infection will be reduced from 27 in 100 to 23 in 100.
 • The risk of needing ear tubes will be reduced from 8 in 100 to 6 in 100.
 • The risk of moderate pneumonia will be reduced from 13 in 1000 to 4 in 1000.
 • The risk of severe pneumonia will be reduced from 7 in 1000 to 2 in 1000.
 • The risk of bacteremia will be reduced from 39 in 10 000 to 11 in 10 000.
 • The risk of meningitis will be reduced from 21 in 100 000 to 6 in 100 000.
 • The risk of deafness from meningitis will be reduced from 27 in 1 million to 8 in 1 million.
 • The risk of permanent disability from meningitis will be reduced from 14 in 1 million to 4 in 1 million.
 • The risk of death from pneumococcal infection will be reduced from 42 in 1 million to 12 in 1 million.