International Journal of Epidemiology 2001;30:571-578
© International Epidemiological Association 2001
Infectious Disease |
Should programmes for community-level meningococcal vaccination be considered in Australia? An economic evaluation
a Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Victoria, 3050 Australia.
b Communicable Diseases Section, Public Health Division, Department of Human Services Victoria, Australia.
c National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia.
Dr Susan Skull, Epidemiology Division, Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia. E-mail: sue.skull{at}mh.org.au
Abstract
Background Disease due to serogroup C Neisseria meningitidis is life-threatening and potentially preventable by vaccination. In 1999, the UK instigated mass vaccination after a sustained increase in serogroup C meningococcal disease. In the same year, Victoria, Australia experienced a similar change in disease epidemiology. It is timely to undertake an economic evaluation of options for community vaccination in Australia based on local data.
Methods Cost-effectiveness and cost-benefit analyses of three options for use of polysaccharide vaccine were undertaken for a hypothetical population aged 15–19 years. Baseline analyses assumed 5 years' duration of vaccine protection following a single year of programme implementation. Sensitivity analyses of key variables were performed, including vaccine coverage and effectiveness, case fatality rate and the discount rate. Outcomes included the number of people vaccinated, cases averted, life-years saved and disability-adjusted life-years (DALY) averted. Cost-benefit analysis used lost earnings avoided as a measure of vaccination benefit.
Results Vaccination of people aged 15–19 years in a defined population with a high rate of disease was the most cost-effective option. Compared with no vaccination and assuming 5 years' duration of protection and exclusion of direct cost savings, this resulted in a discounted cost per life-year saved of $23 623, a cost per DALY avoided of $21 097 and benefits exceeding costs in discounted terms. The ‘break-even’ incidence rate for this option with exclusion of direct cost savings was 14.0/100 000.
Conclusions Community use of polysaccharide vaccination may be cost effective in Australia under certain conditions. Economic evidence favours use of vaccination in well-defined populations with a high rate of disease. Policy decision-making also requires consideration of non-economic factors, including feasibility of implementation and risk perception by the community.
KEY MESSAGES
- In examining options for use of meningococcal vaccine among 15–19-year-olds, vaccination within a defined population with a high rate of disease was the most cost effective.
- The ‘break-even’ incidence rate for this option with exclusion of direct cost savings was 14/100 000.
- Cost-effectiveness ratios were most sensitive to changes in incidence rate, case fatality rate, duration of vaccine effectiveness and the discount rate.
Keywords Neisseria meningitidis, cost-effectiveness analysis, immunization programmes, health planning
Accepted 22 December 2000