Adolescent and adult immunizations: health impact and cost-effectiveness
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Background/Aims: The scope of vaccines recommended for adolescents and adults by ACIP has grown in number of vaccines and populations covered. We estimated the relative health impact and cost-effectiveness of these vaccines to help guide quality improvement initiative decisions.
Methods: Markov deterministic and micro-simulation models were used to estimate the health impact and CE ratios for birth cohorts of four million using a societal perspective. All models used methods consistent with the ‘reference case’ of the Panel of Cost-Effectiveness in Health and Medicine, producing results that are comparable and suitable for ranking. The influenza model recognized the 2010 ACIP recommendation for universal vaccination. The pneumococcal model recognized the recent decline in adult incidence after introduction of the PCV7 childhood vaccine. The meningococcal model included the 2010 ACIP recommendation for a booster five years after an initial vaccination at age 11 or 12. The HPV model estimated the influence of vaccine on rates of cervical cancer with and without cancer screening. Parameter estimates were from published literature. Single- and multiple-variable sensitivity analyses were performed.
Results: Health impacts, measured as QALYs saved during the lifetime of the cohort, were greatest for influenza vaccine (283,300), followed by HPV vaccine with screening (221,100), pneumococcal vaccine (17,100) and meningococcal vaccine (2,900). CE ratios ranged from $9,300 for adult pneumococcal vaccination to over $640,000 for adolescent meningococcal vaccination. CE of influenza vaccination for ages 18 and older was $6,100, but the vaccine was most cost-effective for ages 65 and older ($4,000) and least cost-effective for ages 18 to 49 ($260,500). HPV vaccine CE was $15,100 without screening and $17,900 with screening. Results from micro-simulation of the zoster vaccine will also be presented.
Conclusions: Priority among preventive health care services is important because of the limited time and resources of the health care delivery system and the need to focus on the most effective services. Our consistent methods allow for comparison of estimates across a number of services. Our updated models showed the greatest health impact from HPV vaccine in the presence of screening and influenza vaccination of adults ages 65 and older.