IN3 Translating Outcomes from a Dynamic Transmission Model for Varicella Vaccination to Cost-Effectiveness Estimates: The Impact of Different Analytic Approaches on the Results

ABSTRACTAIMIn Switzerland, human papillomavirus (HPV) vaccination has been implemented using a quadrivalent vaccine that covers HPV types 16 and 18, responsible for about 70% of cervical cancer. The average national uptake was 56% in girls by the age of 16 years in 2014–2016. A nonavalent vaccine, covering five additional oncogenic HPV types was recommended at the end of 2018. The primary aim of this study was to assess the impact and cost-effectiveness of introducing the nonavalent HPV vaccine in Switzerland compared with the quadrivalent vaccine.METHODSWe developed a dynamic transmission model that describes the spread of 10 high risk HPV types. We informed the model with Swiss data about sexual behaviour and cervical cancer screening, and calibrated the model to cervical cancer incidence in Switzerland. We modelled the impact of quadrivalent and nonavalent vaccines at the achieved (56%) and national recommended uptake (80%) in girls. We calculated the incremental cost-effectiveness ratio (ICER) between the nonavalent vaccine, the quadrivalent vaccine and no vaccination. We evaluated costs linked to cervical cancer screening, treatment of different disease stages and vaccination in a sensitivity analysis.RESULTSCompared with quadrivalent HPV vaccination in Switzerland at 56% uptake, vaccinating with the nonavalent vaccine would avert 1,175 cervical cancer deaths, 3,641 cases of cervical cancer and 106,898 CIN treatments over 100 years at 56% uptake. Compared with the quadrivalent vaccine, which would prevent an estimated 67% and 72% of cervical cancer cases at 56% and 80% coverage, the nonavalent vaccine would prevent 83% and 89% of all cervical cancers at the same coverage rates. The sensitivity analysis shows that introducing the nonavalent vaccination should improve health outcomes and offers a cost-saving alternative to the quadrivalent vaccine under the current price difference.CONCLUSIONSAll scenarios with quadrivalent and nonavalent vaccination are likely to be cost-effective compared with no vaccination. Switching to the nonavalent vaccine at current and improved vaccination uptake is likely to be cost-saving under the investigated price difference.

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Cost-effectiveness of alternative strategies for vaccination of adolescents against serogroup B IMD with the MenB-FHbp vaccine in Canada

Can J Public Health ◽

10.17269/s41997-019-00275-4 ◽

2020 ◽

Vol 111 (2) ◽

pp. 182-192 ◽

Cited By ~ 1

Author(s):

Marie-Claude Breton ◽

Liping Huang ◽

Sonya J. Snedecor ◽

Noelle Cornelio ◽

Fiorella Fanton-Aita

Keyword(s):

Cost Effectiveness ◽

Disease Incidence ◽

Health Impact ◽

Population Based ◽

Quality Adjusted Life Year ◽

Transmission Model ◽

Immunization Strategies ◽

Dynamic Transmission Model ◽

Significant Public Health ◽

The Impact

Abstract Objective Serogroup B meningococci (MnB) are now the largest cause of invasive meningococcal disease (IMD) in Canada. We assessed the clinical and economic impact of 3 adolescent MenB-FHbp immunization strategies. Methods A population-based dynamic transmission model was developed to simulate the transmission of MnB among the entire Canadian population over a 30-year time horizon. Age group-based IMD incidence, bacterial carriage and transmission, disease outcomes, costs, and impact on quality of life were obtained from Canadian surveillance data and published literature. The vaccine was assumed to provide 85% protection against IMD and 26.6% against carriage acquisition. The model estimated the impact of routine vaccination with MenB-FHbp in 3 strategies: (1) age 14, along with existing school-based programs, with 75% uptake; (2) age 17 with 75% uptake, assuming school vaccination; and (3) age 17 with 30% uptake, assuming vaccination outside of school. Costs were calculated from the Canadian societal perspective. Results With no vaccination, an estimated 3974 MnB cases would be expected over 30 years. Vaccination with strategies 1–3 were estimated to avert 688, 1033, and 575 cases, respectively. These outcomes were associated with incremental costs per quality-adjusted life-year of $976,000, $685,000, and $490,000. Conclusions Our model indicated that if the vaccine reduces risk of carriage acquisition, vaccination of older adolescents, even at lower uptake, could have a significant public health impact. Due to low disease incidence, MnB vaccination is unlikely to meet widely accepted cost-effectiveness thresholds, but evaluations of new programs should consider the overall benefits of the vaccination.

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Clinical and economic impact of universal varicella vaccination in Norway: A modeling study

PLoS ONE ◽

10.1371/journal.pone.0254080 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0254080

Author(s):

Manjiri Pawaskar ◽

Colleen Burgess ◽

Mathew Pillsbury ◽

Torbjørn Wisløff ◽

Elmira Flem

Keyword(s):

Cost Saving ◽

Varicella Vaccine ◽

Vaccination Strategy ◽

Quadrivalent Vaccine ◽

Transmission Model ◽

Varicella Vaccination ◽

Vaccination Strategies ◽

Dynamic Transmission Model ◽

Life Years ◽

The Impact

Background Norway has not implemented universal varicella vaccination, despite the considerable clinical and economic burden of varicella disease. Methods An existing dynamic transmission model of varicella infection was calibrated to age-specific seroprevalence rates in Norway. Six two-dose vaccination strategies were considered, consisting of combinations of two formulations each of a monovalent varicella vaccine (Varivax® or Varilrix®) and a quadrivalent vaccine against measles-mumps-rubella-varicella (ProQuad® or PriorixTetra®), with the first dose given with a monovalent vaccine at age 15 months, and the second dose with either a monovalent or quadrivalent vaccine at either 18 months, 7 or 11 years. Costs were considered from the perspectives of both the health care system and society. Quality-adjusted life-years saved and incremental cost-effectiveness ratios relative to no vaccination were calculated. A one-way sensitivity analysis was conducted to assess the impact of vaccine efficacy, price, the costs of a lost workday and of inpatient and outpatient care, vaccination coverage, and discount rate. Results In the absence of varicella vaccination, the annual incidence of natural varicella is estimated to be 1,359 per 100,000 population, and the cumulative numbers of varicella outpatient cases, hospitalizations, and deaths over 50 years are projected to be 1.81 million, 10,161, and 61, respectively. Universal varicella vaccination is projected to reduce the natural varicella incidence rate to 48–59 per 100,000 population, depending on the vaccination strategy, and to reduce varicella outpatient cases, hospitalizations, and deaths by 75–85%, 67–79%, and 75–79%, respectively. All strategies were cost-saving, with the most cost-saving as two doses of Varivax® at 15 months and 7 years (payer perspective) and two doses of Varivax® at 15 months and 18 months (societal perspective). Conclusions All modeled two-dose varicella vaccination strategies are projected to lead to substantial reductions in varicella disease and to be cost saving compared to no vaccination in Norway.

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Cost-effectiveness of influenza control measures: a dynamic transmission model-based analysis

Epidemiology and Infection ◽

10.1017/s0950268813000423 ◽

2013 ◽

Vol 141 (12) ◽

pp. 2581-2594 ◽

Cited By ~ 7

Author(s):

S.-C. CHEN ◽

C.-M. LIAO

Keyword(s):

Cost Effectiveness ◽

Natural Ventilation ◽

Seasonal Influenza ◽

School Setting ◽

Control Measures ◽

Transmission Model ◽

Model Based ◽

Dynamic Transmission Model ◽

Influenza Transmission ◽

The Cost

SUMMARYWe investigated the cost-effectiveness of different influenza control strategies in a school setting in Taiwan. A susceptible-exposure-infected-recovery (SEIR) model was used to simulate influenza transmission and we used a basic reproduction number (R0)–asymptomatic proportion (θ) control scheme to develop a cost-effectiveness model. Based on our dynamic transmission model and economic evaluation, this study indicated that the optimal cost-effective strategy for all modelling scenarios was a combination of natural ventilation and respiratory masking. The estimated costs were US$10/year per person in winter for one kindergarten student. The cost for hand washing was estimated to be US$32/year per person, which was much lower than that of isolation (US$55/year per person) and vaccination (US$86/year per person) in containing seasonal influenza. Transmission model-based, cost-effectiveness analysis can be a useful tool for providing insight into the impacts of economic factors and health benefits on certain strategies for controlling seasonal influenza.

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