Current infant vaccination against pneumococcal infection not cost effective

The current pneumococcal vaccination of infants turns out not to be cost effective in the Netherlands. Whereas in the US, partly thanks to indirect positive effects, it has been shown that the vaccination against inter alia meningitis is cost effective, in the Netherlands slightly negative indirect effects have been observed. Researchers from the University of Groningen and the University Medical Center Groningen and colleagues have published this in an article that appeared in the British Medical Journal on 19 June 2010.

Pneumococci are bacteria that can cause serious illnesses such as meningitis, blood poisoning and pneumonia. They are also responsible for less serious, much more common disorders such as otitis media (inflammation of the middle ear). Pneumococcal infections are particularly common among young children and the elderly.

Health Council Advice

Since 2001, the Netherlands has had a ‘conjugated’ vaccine for the prevention of pneumococcal infections in children. The vaccine offers protection against seven common pneumococcal types (7-valence vaccine), which used to cause about 60-70 percent of the serious pneumococcal infections in young children.
However, in 2002, the Health Council of the Netherlands advised not yet to include the vaccine in the national vaccination programme, partly due to unfavourable cost effectiveness ratios (€ 70,000/QALY; QALY = quality-adjusted life year).

Indirect positive effect

However, in the US, vaccination was introduced immediately after registration in 2000. It turned out that there were not only fewer infections and less illness among vaccinated children, but also among people who had not been inoculated, such as the parents and grandparents of vaccinated babies. Taking these ‘indirect’ positive effects of vaccination into account, the cost effectiveness in the new calculations for the Netherlands in 2005 were estimated at less than € 20,000/QALY.

Increase in illness

Partly on the basis of this favourable cost effectiveness ratio, in 2006 the pneumococcal vaccine for infants (using a 4-dose plan) was included in the national vaccination programme.
However, the favourable indirect positive effects were not observed in the Netherlands, or in France, or in the United Kingdom, and certainly not to the same degree as in the US.
On the contrary, an increase in illness caused by pneumococcal types not included in the vaccine was observed – indirect negative effects. The researchers used this new data to calculate a ratio of € 114,000/QALY and conclude that vaccination with the 7-valence vaccine in the Netherlands is not or no longer cost effective.

New vaccines

In the meantime, two new pneumococcal vaccines have become available offering a broader coverage than the current 7-valence vaccine. It also appears that a vaccination plan of three instead of four doses may perhaps offer sufficient protection and thus cost reductions. Based on the above most recent insights, the researchers have calculated the cost effectiveness of the new pneumococcal vaccines (10-valence and 13-valence).

Acceptable alternative

The new multi-valence vaccines offer more health advantages because they offer protection against more types, which probably means that fewer illnesses will be caused by pneumococcal types not included in the vaccine and that more indirect positive effects can be expected among the elderly. These effects mean that the cost effectiveness can fall to ratios that may be acceptable in the Netherlands, < € 50,000/QALY, particularly if the total costs of the vaccination programme can be reduced by slimmed-down vaccination plans or price reductions, or a combination of the two.

Note for the press

More information: Prof. Maarten J. Postma, department of Pharmaco-epidemiology and Pharmaco-economics, University of Groningen; m.j.postma rug.nl; tel. 050–363 2607.