Children Adolescents or Adults The Costeffectiveness of Vaccines

Children, Adolescents, or Adults? The Cost-effectiveness of Vaccines Recommended for Different Age Groups Ismael Ortega Sanchez, Ph. D NIP-CDC

Outline • Warning about terminology • Evolution of vaccine programs and diseases • Cost-effectiveness in pediatrics’ vaccines • New vaccines new clients: Adolescents’ vaccines • Cost-effectiveness in some adults’ vaccines

Disclaimer

Cost-Effectiveness Analysis (CEA) A method used to compare the cost of an intervention to its effectiveness where effectiveness is measured in natural health outcomes (E. g. , cases averted, deaths averted, years of life saved).

Cost-Utility Analysis (CUA) A method used to compare costs and benefits of interventions where benefits are expressed as the number of life years saved adjusted to account for loss of quality.

Cost-Benefit Analysis (CBA) A method used to compare costs and benefits of an intervention where all the consequences and benefits are valued in monetary terms.

Evolution of Vaccine Demand Prominence of Vaccine Safety Pre-vaccination Increasing Coverage Loss of Reassumption Eradication Confidence “? ” Di se a Ou tbr ea k Va co cci ve ne ra ge se vents e Adverse Elimination

Infant and Children Vaccines

Vaccine-specific Coverage Rates Among Pre-school Aged Children Source: NHIS (1991 -1993) CDC, NCHS, and NIS (1994 -December 2003),

Cost to Fully Vaccinate a Child in Public Sector (vaccine cost only)

Annual Morbidity in Pediatric Vaccine-Preventable Diseases Source: CDC. MMWR April 2, 1999. 48: * Source: CDC. MMWR January 9, 2004. 52 ‡ Data are estimated. †

Monthly reported varicella cases and annual vaccination coverage -- Antelope Valley* CA, 1995 -2003 1995 1996 1997 1998 1999 *Varicella Active Surveillance Project site 2000 2001 2002 2003

Varicella-related Hospitalization Rates* 1994 -2002 14. 0 Rate (per 100, 000 pop. ) 12. 0 10. 0 8. 0 <10 yrs 10 -19 yrs 20 -49 yrs 6. 0 4. 0 2. 0 0 1994 1995 1996 1997 1998 Year 1999 Source: Zhou et al (forthcoming) based on MEDSTAT * Varicella as the primary diagnosis code 2000 2001 2002

Invasive Pneumococcal Disease Rates by Age and Year Children <5 Years, 1 yr <1 yr 2003 vs baseline - 77% (<1 yr) - 83% (1 yr) - 64% (2 yr) - 60% (3 yr) - 48% (4 yr) 2 yrs 3 yrs 4 yrs Source: ABCs (April 2004), Observed Rates Sites: CA (SF co), CT, GA (20 co), MD (6 co), MN (7 co), NY (7 co), OR (3 co) 2003 data are preliminary

Benefit-Cost Ratios for Selected Vaccines (in US Dollars)* * From 2003 IOM report

New Vaccines New Clients: Vaccines for Adolescents

New Vaccines New Clients

Annual Cases of Cervical Cancer and Costs Attributable to HPV Infection Cancer Stage Localized to Cervix Regional Spread Distant Spread Total Cases 7, 360 Cost* 91. 3 4, 352 53. 7 1, 088 21. 9 12, 800 166. 9 *Costs are in millions of 2003 US dollars

Total Costs Attributable to HPV Infection Annually External Genital Warts Abnormal Paps† Invasive Cervical Cancer Total Women* Men* 127. 0 4, 086. 5 166. 9 4, 380. 4 127. 0 *Costs are in millions of 2003 US dollars †Shown are all costs incurred in follow-up care for abnormal Pap tests

Meningococcal disease incidence and Case fatality ratio* * ABCs data, 1993 -2002

Costs of routine vaccination of 11 -12 yrs. US adolescents with conjugate meningococcal vaccine* Societal cost of disease Direct cost of disease No Vaccination Cost (Savings) from vaccination † $146 $78 $111 - $184 $42 - $109 ($68) $38 $20 $23 - $58 $10 - $34 * Costs are in millions of 2003 US dollars † Savings before vaccination program costs ($18)

Pertussis Incidence and Cost per Case and Type* Source: Lee GM et al, CID 2004: 39 † Total costs exclude productivity losses due to death

Cost-effectiveness of Potential Vaccine Programs for Adolescents* * Cost converted to 2003 $

Vaccines for Adults and the Elderly

Cost-effectiveness of for Some Vaccine Programs for Adults and Elderly* * Cost converted to 2002 $

Adults and Vaccines Understanding Incentives

Influenza Vaccination Coverage Levels by Race/Ethnicity, 1989 -2000 White Hispanic African-American National Health Interview Survey 1989 -2000

Influenza Reports By Season*, VAERS 7/1990 -1/2003 * Calculated by vaccination date, all ages

Unadjusted Vaccination Rates by Program Characteristic Liability insurance No insurance Invite specific persons Don’t invite * Post-vax job policy No policy Compensation for AEs No compensation Vaccine on own time Vaccine during work * * Health Department Hospital * Statistically significant difference p < 0. 05

DISCUSSION

Doses of Varicella Vaccine Distributed by Year by Sector