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Economic analysis of pandemic influenza vaccination strategies in Singapore.

Lee VJ, Tok MY, Chow VT, Phua KH, Ooi EE, Tambyah PA, Chen MI - PLoS ONE (2009)

Bottom Line: The actual pandemic vaccine effectiveness and lead time is unknown.Vaccine stockpiling as insurance against worst-case scenarios is also cost-effective.Research and development is therefore critical to develop and stockpile cheap, readily available effective vaccines.

View Article: PubMed Central - PubMed

Affiliation: Center for Health Services Research, National University of Singapore, Singapore, Singapore. vernonljm@hotmail.com

ABSTRACT

Background: All influenza pandemic plans advocate pandemic vaccination. However, few studies have evaluated the cost-effectiveness of different vaccination strategies. This paper compares the economic outcomes of vaccination compared with treatment with antiviral agents alone, in Singapore.

Methodology: We analyzed the economic outcomes of pandemic vaccination (immediate vaccination and vaccine stockpiling) compared with treatment-only in Singapore using a decision-based model to perform cost-benefit and cost-effectiveness analyses. We also explored the annual insurance premium (willingness to pay) depending on the perceived risk of the next pandemic occurring.

Principal findings: The treatment-only strategy resulted in 690 deaths, 13,950 hospitalization days, and economic cost of USD$497 million. For immediate vaccination, at vaccine effectiveness of >55%, vaccination was cost-beneficial over treatment-only. Vaccine stockpiling is not cost-effective in most scenarios even with 100% vaccine effectiveness. The annual insurance premium was highest with immediate vaccination, and was lower with increased duration to the next pandemic. The premium was also higher with higher vaccine effectiveness, attack rates, and case-fatality rates. Stockpiling with case-fatality rates of 0.4-0.6% would be cost-beneficial if vaccine effectiveness was >80%; while at case-fatality of >5% stockpiling would be cost-beneficial even if vaccine effectiveness was 20%. High-risk sub-groups warrant higher premiums than low-risk sub-groups.

Conclusions: The actual pandemic vaccine effectiveness and lead time is unknown. Vaccine strategy should be based on perception of severity. Immediate vaccination is most cost-effective, but requires vaccines to be available when required. Vaccine stockpiling as insurance against worst-case scenarios is also cost-effective. Research and development is therefore critical to develop and stockpile cheap, readily available effective vaccines.

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Related in: MedlinePlus

Decision diagram for vaccination versus treatment only.
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pone-0007108-g001: Decision diagram for vaccination versus treatment only.

Mentions: Similar to a previous anti-viral study performed in Singapore [5], this study used a decision-analysis model (Figure 1) to perform cost-benefit and cost-effectiveness assessments for pandemic vaccination in Singapore. The model compared the current pandemic management strategy of early oseltamivir treatment and supportive management (treatment only) against pandemic vaccination in addition to early treatment (vaccination).


Economic analysis of pandemic influenza vaccination strategies in Singapore.

Lee VJ, Tok MY, Chow VT, Phua KH, Ooi EE, Tambyah PA, Chen MI - PLoS ONE (2009)

Decision diagram for vaccination versus treatment only.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2743808&req=5

pone-0007108-g001: Decision diagram for vaccination versus treatment only.
Mentions: Similar to a previous anti-viral study performed in Singapore [5], this study used a decision-analysis model (Figure 1) to perform cost-benefit and cost-effectiveness assessments for pandemic vaccination in Singapore. The model compared the current pandemic management strategy of early oseltamivir treatment and supportive management (treatment only) against pandemic vaccination in addition to early treatment (vaccination).

Bottom Line: The actual pandemic vaccine effectiveness and lead time is unknown.Vaccine stockpiling as insurance against worst-case scenarios is also cost-effective.Research and development is therefore critical to develop and stockpile cheap, readily available effective vaccines.

View Article: PubMed Central - PubMed

Affiliation: Center for Health Services Research, National University of Singapore, Singapore, Singapore. vernonljm@hotmail.com

ABSTRACT

Background: All influenza pandemic plans advocate pandemic vaccination. However, few studies have evaluated the cost-effectiveness of different vaccination strategies. This paper compares the economic outcomes of vaccination compared with treatment with antiviral agents alone, in Singapore.

Methodology: We analyzed the economic outcomes of pandemic vaccination (immediate vaccination and vaccine stockpiling) compared with treatment-only in Singapore using a decision-based model to perform cost-benefit and cost-effectiveness analyses. We also explored the annual insurance premium (willingness to pay) depending on the perceived risk of the next pandemic occurring.

Principal findings: The treatment-only strategy resulted in 690 deaths, 13,950 hospitalization days, and economic cost of USD$497 million. For immediate vaccination, at vaccine effectiveness of >55%, vaccination was cost-beneficial over treatment-only. Vaccine stockpiling is not cost-effective in most scenarios even with 100% vaccine effectiveness. The annual insurance premium was highest with immediate vaccination, and was lower with increased duration to the next pandemic. The premium was also higher with higher vaccine effectiveness, attack rates, and case-fatality rates. Stockpiling with case-fatality rates of 0.4-0.6% would be cost-beneficial if vaccine effectiveness was >80%; while at case-fatality of >5% stockpiling would be cost-beneficial even if vaccine effectiveness was 20%. High-risk sub-groups warrant higher premiums than low-risk sub-groups.

Conclusions: The actual pandemic vaccine effectiveness and lead time is unknown. Vaccine strategy should be based on perception of severity. Immediate vaccination is most cost-effective, but requires vaccines to be available when required. Vaccine stockpiling as insurance against worst-case scenarios is also cost-effective. Research and development is therefore critical to develop and stockpile cheap, readily available effective vaccines.

Show MeSH
Related in: MedlinePlus