Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
The European Journal of Health Economics
Published in: The European Journal of Health Economics 1/2009

01-02-2009 | Original paper

Cost effectiveness analysis of heptavalent pneumococcal conjugate vaccine in Germany considering herd immunity effects

Authors: Christa Claes, Ralf René Reinert, Johann-Matthias Graf von der Schulenburg

Published in: The European Journal of Health Economics | Issue 1/2009

Login to get access

Abstract

Background

In Germany the heptavalent pneumococcal conjugate vaccine (PCV7) has been recommended as a general infant vaccination since 2006. Data from similar programmes in the USA have reported a reduction of pneumococcal diseases in both vaccinated and unvaccinated populations, suggesting herd immunity effects. This study analyses the cost-effectiveness of a general vaccination with PCV7 in Germany based on these findings.

Methods

A Markov model adapts efficacy and herd immunity data to the German population. Further main model inputs are incidence, vaccination uptake, serotype distribution, case fatality rates, and vaccination and health-care costs.

Results

A general vaccination with PCV7 would avoid about 232,000 pneumococcal infections and 1,879 premature deaths per year in Germany. From the health-care payer's perspective, direct cost savings would outweigh vaccination expenditures by a ratio of 1:1.16. The sensitivity analysis shows that these estimates are quite conservative.

Conclusion

Based on the health-economic evaluation, the authors recommend the continuation of the general recommendation of PCV7 according to the 3 + 1 schedule within the German Statutory Health Insurance.
Literature
1.
Asensi, F., De Jose, M., Lorente, M., Moraga, F., Ciuryla, V., Arikian, S., Casciano, R., Vento, M.: A pharmacoeconomic evaluation of seven-valent pneumococcal conjugate vaccine in Spain. Value. Health. 7, 36–51 (2004)CrossRef
2.
Balk, R.A.: Severe sepsis and septic shock. Crit. Care Clin. 16, 179–192 (2000)CrossRef
3.
Barker, L., Luman, E., Zhao, Z., Smith, P., Linkins, R., Santoli, J., Rodewald, L., McCauley, M.: National, state, and urban area vaccination coverage levels among children aged 19–35 months—United States, 2001. Morb. Mortal. Wkly. Rep. 51, 664–666 (2002)
4.
Baxter, R., Black, S., Shinefield, H., Fireman, B.: Impact of seven-valent pneumococcal conjugate vaccine (PCV) on antibiotic resistance within Northern California Kaiser Permanente (NCKP) (abstract). In: 41st Annual Meeting of IDSA, San Diego, 9–12 October 2003
5.
Bernard, G.R., Vincent, J.L., Laterre, P.F., LaRosa, S.P., Dhainaut, J.F., Lopez-Rodriguez, A., Steingrub, J.S., Garber, G.E., Helterbrand, J.D., Ely, E.W., Fisher, C.J. Jr.: Efficacy and safety of recombinant human activated protein C for severe sepsis. N. Engl. J. Med. 344, 699–709 (2001)CrossRef
6.
Beutels, P., Van Damme, P., Oosterhuis-Kafeja, F.: Effects and costs of pneumococcal conjugate vaccination of Belgian children. Health. Technol. Assess. (HTA). Brussels (2006)
7.
Black, S.: Decline in invasive pneumococcal disease after the introduction of protein-polysaccharide conjugate vaccine. J. Pediatr. 143, 688–689 (2003)
8.
Black, S., Shinefield, H., Fireman, B., Lewis, E., Ray, P., Hansen, J.R., Elvin, L., Ensor, K.M., Hackell, J., Siber, G., Malinoski, F., Madore, D., Chang, I., Kohberger, R., Watson, W., Austrian, R., Northern California Kaiser Permanente Vaccine Study Center Group: efficacy, safety and immunogenicity of heptavalent pneumococcal conjugate vaccine in children. Pediatr. Infect. Dis. J. 19, 187–195 (2000)
9.
Black, S.B., Shinefield, H.R., Ling, S., Hansen, J., Fireman, B., Spring, D., Noyes, J., Lewis, E., Ray, P., Lee, J., Hackell, J.: Effectiveness of heptavalent pneumococcal conjugate vaccine in children younger than five years of age for prevention of pneumonia. Pediatr. Infect. Dis. J. 21, 810–815 (2002)CrossRef
10.
Bos, J.M., Rumke, H., Welte, R., Postma, M.J.: Epidemiologic impact and cost-effectiveness of universal infant vaccination with a 7-valent conjugated pneumococcal vaccine in the Netherlands. Clin. Ther. 25, 2614–2630 (2003)CrossRef
11.
Breiman, R.F., Spika, J.S., Navarro, V.J., Darden, P.M., Darby, C.P.: Pneumococcal bacteremia in Charleston county, South Carolina. A decade later. Arch. Intern. Med. 150, 1401–1405 (1990)CrossRef
12.
Bundesverband der Pharmazeutischen Industrie e.V. (BPI) (Hrsg.): Pharma-Daten 2006, 36. überarbeitete Auflage. Berlin (2006)
13.
Butler, J.R., McIntyre, P., MacIntyre, C.R., Gilmour, R., Howarth, A.L., Sander, B.: The cost-effectiveness of pneumococcal conjugate vaccination in Australia. Vaccine 22, 1138–1149 (2004)CrossRef
14.
Claes, C., Schulenburg, J.M. Graf von der.: Cost effectiveness of pneumococcal vaccination for infants and children with the conjugate vaccine PnC-7 in Germany. Pharmacoeconomics 21, 587–600 (2003)
15.
16.
De Wals, P., Petit, G., Erickson, L.J., Guay, M., Tam, T., Law, B., Framarin, A.: Benefits and costs of immunization of children with pneumococcal conjugate vaccine in Canada. Vaccine 21, 3757–3764 (2003)CrossRef
17.
Deutsche Rentenversicherung Bund (Hrsg.): Rentenversicherung in Zahlen 2007. Berlin (2007)
18.
Eisenmenger, M.: Sterbetafel 2001/2003. Wirtschaft und Statistik. 5, 463–478 (2005)
19.
Eisenmenger, M., Poetzsch O., Sommer B.: 11. Koordinierte Bevölkerungs-Vorausberechnung. Annahmen und Ergebnisse, Wiesbaden (2006)
20.
Eskola, J., Kilpi, T., Palmu, A., Jokinen, J., Haapakoski, J., Herva, E., Takala, A., Käyhty, H., Karma, P., Kohberger, R., Siber, G., Mäkelä, P.H.: Finnish Otitis Media Study Group: efficacy of a pneumococcal conjugate vaccine against acute otitis media. N. Engl. J. Med. 344, 403–409 (2001)
21.
Ess, S.M., Schaad, U.B., Gervaix, A., Pinosch, S., Szucs, T.D.: Cost-effectiveness of a pneumococcal conjugate immunisation program for infants in Switzerland. Vaccine 21, 3273–3281 (2003)CrossRef
22.
Fedson, D.S., Musher, D.M.: Pneumococcal vaccine. In: Plotkin, S.A., Mortimer, E Jr. (eds.) Vaccine, 2nd edn pp. 517–564. Saunders, Philadelphia (1994)
23.
Fireman, B., Black, S.B., Shinefield, H.R., Lee, J., Lewis, E., Ray, P.: Impact of the pneumococcal conjugate vaccine on otitis media. Pediatr. Infect. Dis. J. 22, 10–16 (2003)CrossRef
24.
Ford, M.W., Grace, E., Wand, E.C.: The clinical and economic impact of pneumococcal conjugate vaccine associated herd immunity in Canada. J. Med. Econ. 7, 85–92 (2004)
25.
Gemeinsamer Bundesausschuss (Hrsg.): Beschluss des Gemeinsamen Bundesausschusses über eine Richtlinie über Schutzimpfungen nach § 20 d Abs. 1. SGB V (Schutzimpfungs-Richtlinie / SiR): Regelung des Anspruches der Versicherten auf Leistungen für Schutzimpfungen gemäß § 29 Abs. 1 Satz 2 Nr. 15 SGB V vom 21. Juni 2007. URL: http://​www.​g-ba.​de/​cms/​front_​content.​php?​idcat=​56 (Accessed 10 Jan 2008)
26.
Gesetz zur Stärkung des Wettbewerbs in der gesetzlichen Krankenversicherung (GKV-Wettbewerbsstärkungsgesetz — GKV-WSG) vom 26. März 2007. Bundesgesetzblatt Teil 1 Nr. 11, 378–473 (2007)
27.
Grijalva, C.G., Nuorti, J.P., Arbogast, P.G., Martin, S.W., Edwards, K.M., Griffin, M.R.: Decline in pneumonia admissions after routine childhood immunisation with pneumococcal conjugate vaccine in the USA: a time-series analysis. Lancet 369, 1179–1186 (2007)
28.
Grijalva, C.G., Poehling, K.A., Nuorti, J.P., Zhu, Y., Martin, S.W., Edwards, K.M., Griffin, M.R.: National impact of universal childhood immunization with pneumococcal conjugate vaccine on outpatient medical care visits in the United States. Pediatrics 118, 865–873 (2006)CrossRef
29.
Hallauer, J.F.: Aktueller Stand de Pneumokokkenerkrankungen in Deutschland und der Nutzung der konjugierten Pneumokokkenvakzine. Gesundheitsökonomie und Qualitätsmanagement 11, 43–55 (2006)CrossRef
30.
Hueston, W.J., Mainous, A.G. III, Brauer, N.: Predicting cost-benefits before programs are started: looking at conjugate vaccine for invasive pneumococcal infections. J. Community. Health. 25, 23–33 (2000)CrossRef
31.
Hülße, C., Ley, S., Stück, B.: Ärztemerkblatt Pneumokokken. Verlag im Kilian, Marburg (1999)
32.
33.
Imran, M.N., Leng, P.H., Yang, S., Kurup, A., Eng, P.: Early predictors of mortality in pneumococcal bacteraemia. Ann. Acad. Med. Singapore. 34, 426–431 (2005)
34.
35.
Kalies, K., Hermann, M., Schmitt, H.J., Kries, R.V.: Prävention invasiver Pneumokokken Infektionen im Kindersalter. Welche Impfstrategie ist zu empfehlen? Kinderärztliche Praxis. 72, 90–98 (2001)
36.
Kalin, M., Ortqvist, A., Almela, M., Aufwerber, E., Dwyer, R., Henriques, B., Jorup, C., Julander, I., Marrie, T.J., Mufson, M.A., Riquelme, R., Thalme, A., Torres, A., Woodhead, M.A.: Prospective study of prognostic factors in community-acquired bacteremic pneumococcal disease in 5 countries. J. Infect. Dis. 182, 840–847 (2000)CrossRef
37.
Kaplan, V., Angus, D.C., Griffin, M.F., Clermont, G., Scott, W.R., Linde-Zwirble, W.T.: Hospitalized community-acquired pneumonia in the elderly: age- and sex-related patterns of care and outcome in the United States. Am.J. Respir. Crit. Care Med. 165, 766–772 (2002)
38.
von Kries, R., Siedler, A., Schmitt, H.J., Reinert, R.R.: Proportion of invasive pneumococcal infections in German children preventable by pneumococcal conjugate vaccines. Clin. Infect. Dis. 31, 482–487 (2000)CrossRef
39.
von Kries, R., Toschke, A.M., Siedler, A., Reinert, R.R.: Population-based nationwide study on invasive pneumococcal infections among children in Germany (1997–2003). (2005)
40.
Lebel, M.H., Kellner, J.D., Ford-Jones, E.L., Hvidsten, K., Wang, E.C., Ciuryla, V., Arikian, S., Casciano, R.: A pharmacoeconomic evaluation of 7-valent pneumococcal conjugate vaccine in Canada. Clin. Infect. Dis. 36, 259–268 (2003)CrossRef
41.
Lexau, C.A., Lynfield, R., Danila, R., Pilishvili, T., Facklam, R., Farley, M.M., Harrison, L.H., Schaffner, W., Reingold, A., Bennett, N.M., Hadler, J., Cieslak, P.R., Whitney, C.G.: Changing epidemiology of invasive pneumococcal disease among older adults in the era of pediatric pneumococcal conjugate vaccine. J. Am. Med. Assoc. 294, 2043–2051 (2005)CrossRef
42.
Ley, S., Stück, B.: Pneumokokken-Infektionen: Ältere Menschen. Immunologie & Impfen. 2, 128–133 (1999)
43.
Lieu, T.A., Ray, G.T., Black, S.B., Butler, J.C., Klein, J.O., Breiman, R.F., Miller, M.A., Shinefield, H.R.: Projected cost-effectiveness of pneumococcal conjugate vaccination of healthy infants and young children. J. Am. Med. Assoc. 283, 1460–1468 (2000)CrossRef
44.
Lloyd, A., Patel, N., Scott, D.A., Runge, C., Claes, C., Rose, M.: Cost-effectiveness of heptavalent conjugate pneumococcal vaccine (Prevenar) in Germany: considering a high-risk population and herd immunity effects. Eur. J. Health. Econ. [Epub ahead of print] (2007)
45.
Marchetti, M., Colombo, G.L.: Cost-effectiveness of universal pneumococcal vaccination for infants in Italy. Vaccine 23, 4565–4576 (2005)CrossRef
46.
McIntosh, E.D., Conway, P., Willingham, J., Hollingsworth, R., Lloyd, A.: Pneumococcal pneumonia in the UK—how herd immunity affects the cost-effectiveness of 7-valent pneumococcal conjugate vaccine (PCV). Vaccine 23, 1739–1745 (2005)CrossRef
47.
McIntosh, E.D., Conway, P., Willingham, J., Lloyd, A.: The cost-burden of paediatric pneumococcal disease in the UK and the potential cost-effectiveness of prevention using 7-valent pneumococcal conjugate vaccine. Vaccine 21, 2564–2572 (2003)CrossRef
48.
Melegaro, A., Edmunds, W.J.: Cost-effectiveness analysis of pneumococcal conjugate vaccination in England and Wales. Vaccine 22, 4203–4214 (2004)CrossRef
49.
Moore, D., Bigham, M., Patrick, D.: Modelling the costs and effects of a universal infant immunization program using conjugated pneumococcal vaccine in British Columbia. Can. Commun. Dis. Rep. 29, 97–104 (2003)
50.
Navas, E., Salleras, L., Gisbert, R., Dominguez, A., Timoner, E., Ibanez, D., Prat, A.: Cost-benefit and cost-effectiveness of the incorporation of the pneumococcal 7-valent conjugated vaccine in the routine vaccination schedule of Catalonia (Spain). Vaccine 23, 2342–2348 (2005)CrossRef
51.
Overturf, G.D., American Academy of Pediatrics, Committee on Infectious Diseases: technical report: prevention of pneumococcal infections, including the use of pneumococcal conjugate and polysaccharide vaccines and antibiotic prophylaxis. Pediatrics 106, 367–376 (2000)
52.
Pelton, S.I.: Acute otitis media in the era of effective pneumococcal conjugate vaccine: will new pathogens emerge? Vaccine 19, S96–S99 (2000)CrossRef
53.
Poethko-Müller, C., Kuhnert, R., Schlaud, M.: Durchimpfung und Determinanten des Impfstatus in Deutschlang. Ergebnisse des Kinder-und Jugendgesundheitssurveys (KiGGS). Bundesgesundheitsblatt — Gesundheitsforschung — Gesundheitsschutz 50, 851–862 (2007)CrossRef
54.
Prosser, L.A., Ray, G.T., O’Brien, M., Kleinman, K., Santoli, J., Lieu, T.A.: Preferences and willingness to pay for health states prevented by pneumococcal conjugate vaccine. Pediatrics. 113, 283–290 (2004)CrossRef
55.
Ray, G.T., Whitney, C.G., Fireman, B.H., Ciuryla, V., Black, S.B.: Cost-effectiveness of pneumococcal conjugate vaccine: evidence from the first 5 years of use in the United States incorporating herd effects. Pediatr. Infect. Dis. J. 25, 494–501 (2006)CrossRef
56.
Reinert, R.R., Haupts, S., van der Linden, M., Heeg, C., Cil, M.Y., Al-Lahham, A., Fedson, D.S.: Invasive pneumococcal disease in adults in North-Rhine Westphalia, Germany, 2001–2003. Clin. Microbiol. Infect. 11, 985–991 (2005)
57.
Robert Koch Institut (RKI): Zur Impfung gegen Pneumokokken-Infektionen. Epidemiol. Bull. 12, 97–99 (2000)
58.
Rote Liste® Service GmbH (Hrsg.): Rote Liste. Arzneimittelinformationen für Deutschland (einschließlich EG-Zulassungen und bestimmter Medizinprodukte). Frankfurt (2005)
59.
Rote Liste® Service GmbH (Hrsg.): Rote Liste online. Arzneimittelinformationen für Deutschland (einschließlich EG-Zulassungen und bestimmter Medizinprodukte). URL: http://​www.​rote-liste.​de (Accessed 10 Jan 2008)
60.
Ryan, K.J., Ray, C.G., Sherris, J.C.: (eds.): Sherris Medical Microbilogoy: an introduction to infectious diseases. McGraw-Hill, Cincinnati (2004)
61.
Rüggeberg, J.U., Ketteler, K., MacKenzie, C.R., von Kries, R., Reinert, R.R., Schroten, H.: Blood culture sampling rates at a German pediatric university hospital and incidence of invasive pneumococcal disease. Infection 32, 78–81 (2004)CrossRef
62.
Salo, H., Sintonen, H., Pekka Nuorti, J., Linna, M., Nohynek, H., Verho, J., Kilpi, T.: Economic evaluation of pneumococcal conjugate vaccination in Finland. Scand. J. Infect. Dis. 37, 821–832 (2005)CrossRef
63.
Schnoor, M., Hedicke, J., Dalhoff, K., Raspe, H., Schafer, T.: Approaches to estimate the population-based incidence of community acquired pneumonia. J. Infect. 55, 233–239 (2007)CrossRef
64.
Scholz, H.: Akute Otitis media — Krankheitsbild und Behandlung im Kindesalter. In: Stück B., von Voss H. (eds.) Pneumokokken-Erkrankungen bei Säuglingen und Kleinkindern, pp. 15–22. Verlag im Kilian, Marburg (2001)
65.
Schulenburg, J.M. Graf von der, Greiner, W., Jost, F., Klusen, N., Kubin, M., Leidl, R., Mittendorf, T., Rebscher, H., Schöffski, O., Vauth, C., Volmer, T., Wahler, S., Wasem, J., Weber, C., und die Mitglieder des Hannoveraner Konsens. Deutsche Empfehlungen zur gesundheitsökonomischen Evaluation — dritte und aktualisierte Fassung des Hannoveraner Konsens. Gesundheitsökonomie und Qualitätsmanagement 12, 285–290 (2007)
66.
Schulze-Gattermann, H.: Kosten-Nutzen-Analyse der Cochlea-Implantation bei Kindern. Dissertation, Medizinische Hochschule Hannover (2000)
67.
Schulze-Gattermann, H., Illg, A., Schoenermark, M., Lenarz, T., Lesinski-Schiedat, A.: Cost-benefit analysis of pediatric cochlear implantation: German experience. Otol. Neurotol. 23, 674–681 (2002)CrossRef
68.
69.
Statistisches Bundesamt (Hrsg.): Diagnosedaten der Krankenhäuser nach Behandlungsort ab 2000 (Fälle/Sterbefälle, Pflegetage, durchschnittliche Verweildauer. Gliederungsmerkmale: Jahre, Behandlungsort, Alter, Geschlecht, Verweildauer, ICD10. URL: http://​www.​gbe-bund.​de (Accessed 10 Jan 2008)
70.
Statistisches Bundesamt (Hrsg.): Leben und Arbeiten in Deutschland. Sonderheft 2: Vereinbarkeit von Familie und Beruf. Ergebnisse des Mikrozensus 2005. Wiesbaden (2006)
71.
Statistisches Bundesamt (Hrsg.): Statistisches Jahrbuch 2006. Für die Bundesrepublik Deutschland. Wiesbaden (2006)
72.
Ständige Impfkommission am Robert Koch-Institut (STIKO): Empfehlung der Ständigen Impfkommission (STIKO) am Robert Koch Institut, Stand: Juli 2006. Epidemiol. Bull. 235–254 (2006)
73.
Weycker, D., Richardson, E., Oster, G.: Childhood vaccination against pneumococcal otitis media and pneumonia: an analysis of benefits and costs. Am. J. Manage. Care. 6, S526–S535 (2000)
74.
Whitney, C.G.: Effect of pneumococcal conjugate vaccine on invasive disease in the U.S. (abstract). 4th international symposium on pneumococci and pneumococcal diseases, Helsinki 9–13 May 2004
75.
Whitney, C.G.: Impact of conjugate pneumococcal vaccines. Pediatr. Infect. Dis. J. 24, 729–730 (2005)CrossRef
76.
Whitney, C.G., Farley, M.M., Hadler, J., Harrison, L.H., Bennett, N.M., Lynfield, R., Reingold, A., Cieslak, P.R., Pilishvili, T., Jackson, D., Facklam, R.R., Jorgensen, J.H., Schuchat, A.: Decline in invasive pneumococcal disease after the introduction of protein-polysaccharide conjugate vaccine. N. Engl. J. Med. 348, 1737–1746 (2003)CrossRef
77.
Wisloff, T., Abrahamsen, T.G., Bergsaker, M.A., Lovoll, O., Moller, P., Pedersen, M.K., Kristiansen, I.S.: Cost effectiveness of adding 7-valent pneumococcal conjugate (PCV-7) vaccine to the Norwegian childhood vaccination program. Vaccine 24, 5690–5699 (2006)CrossRef
78.
Metadata
Title
Cost effectiveness analysis of heptavalent pneumococcal conjugate vaccine in Germany considering herd immunity effects
Authors
Christa Claes
Ralf René Reinert
Johann-Matthias Graf von der Schulenburg
Publication date
01-02-2009
Publisher
Springer-Verlag
Published in
The European Journal of Health Economics / Issue 1/2009
Print ISSN: 1618-7598
Electronic ISSN: 1618-7601
DOI
https://doi.org/10.1007/s10198-008-0098-1

Other articles of this Issue 1/2009

The European Journal of Health Economics 1/2009 Go to the issue

Original paper

Health care costs, work productivity and activity impairment in non-malignant chronic pain patients

Original paper

Comparing methodologies for the cost estimation of hospital services

Original paper

Do quality-adjusted life years take account of lost income? Evidence from an Australian survey

Original paper

Cost-effectiveness of linezolid versus vancomycin for hospitalised patients with complicated skin and soft-tissue infections in Germany

Original paper

Cost utility analysis of knee prosthesis with complete microprocessor control (C-leg) compared with mechanical technology in trans-femoral amputees

Editorial

Can we afford to ignore missing data in cost-effectiveness analyses?