Farmaco-economische aspecten van vaccinatie tegen invasieve pneumokokkeninfecties bij 65-plussers; literatuuroverzicht van kosteneffectiviteitsanalysen

To assess the cost-effectiveness of vaccination to prevent invasive pneumococcal disease in the elderly.

Design

Review of the literature.

Methods

Articles in Dutch or English reporting studies into the cost-effectiveness of vaccination for the prevention of invasive pneumococcal infection in persons over 65 years of age were retrieved from Medline (1980-2000; search terms: ‘pneumococcal’ and ‘vaccine’ in combination with ‘costs’ or ‘economics’) and on the basis of the reference lists in the articles found. The following aspects of the selected studies were assessed: the net costs per year of life gained, the incidence of invasive pneumococcal disease in the elderly, the mortality due to invasive pneumococcal infections, the effectiveness of the vaccine in the prevention of invasive pneumococcal infections, and the costs of the vaccine and its administration. Attention was also given to specific age categories and to the effects of varying certain crucial assumptions.

Results

We retrieved a total of five studies: one each for the USA, Canada, the Netherlands and Spain and a multinational study for five European countries. The cost-effectiveness of vaccination of the elderly against invasive pneumococcal infections varied from cost savings to € 33,000,– per life-year gained. The Dutch study estimated the cost-effectiveness at € 10,100,– per life-year gained (price level 1995). Almost all the studies selected based their estimate of the effectiveness of vaccination on the same case-control study from the USA. The potential effects on cost-effectiveness of more extensive influenza vaccination and of the inclusion of re-vaccination against pneumococci were not included in the analyses.

Conclusion

The cost-effectiveness of vaccination against invasive pneumococcal infections in persons over 65 years of age (in the Netherlands as well as in several other countries) was below the previously accepted threshold of € 20,000,–.