Cost-utility analysis of the universal pneumococcal vaccination programme for older adults in Norway.

The aim of this study was to establish whether the universal pneumococcal vaccination for older adults in Norway is likely to be cost-effective from the perspective of the health care provider. A decision tree model developed by the Public Health Agency of Sweden was adapted to the Norwegian setting. Two cohorts, consisting of 65-year-olds and 75-year-olds grouped into vaccinated and unvaccinated, were followed over a 5-year time horizon. In the base case, the 23-valent polysaccharide vaccine (PPV23) was used while the 13-valent pneumococcal conjugate vaccine (PCV13) was included in scenario analyses only. The costs and health benefits (measured in quality adjusted life years (QALY) gained) were compared in the two cohorts between the vaccinated and unvaccinated groups. The impact of indirect effects of the vaccine, such as herd immunity and serotype replacement, were not investigated. The relative importance of change in price was assessed by performing one-way sensitivity analyses. Under base-case assumptions, the programme for the 75-year-old cohort is expected to be dominant (cost-effective) from the health care perspective at the current maximal pharmacy retail price and at 75% vaccination coverage. In comparison, for the 65-year-old cohort the cost per QALY gained is approximately NOK 601,784 (EUR 61,281) under the base-case assumptions. A reduction in the cost of the vaccine to one quarter of its current level also brings the cost per QALY gained within the acceptable ranges in a Norwegian context for both the 65- and 75-year-old cohorts. There is no exact cost-effectiveness threshold in Norway. However, introducing a vaccination programme against pneumococcal disease for 65-year-olds in Norway is likely to fall within the acceptable range while for the 75-year-old cohort the universal programme appears to be dominant (cost-effective).

Inclusion of Additional Unintended Consequences in Economic Evaluation: A Systematic Review of Immunization and Tuberculosis Cost-Effectiveness Analyses.

OBJECTIVE: Our objective was to review economic evaluations of immunization and tuberculosis to determine the extent to which additional unintended consequences were taken into account in the analysis and to describe the methodological approaches used to estimate these, where possible. METHODS: We sourced the vaccine economic evaluations from a previous systematic review by Nymark et al. (2009-2015) and searched PubMed/MEDLINE and Embase from 2015 to 2019 using the same search strategy. For tuberculosis economic evaluations, we extracted studies from 2009 to 2019 that were published in a previous review by Siapka et al. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. Studies were classified according to the categories and subcategories (e.g., herd immunity, non-specific effects, and labor productivity) defined in a framework identifying additional unintended consequences by Nymark and Vassall. Where possible, methods for estimating the additional unintended consequences categories and subcategories were described. We evaluated the reporting quality of included studies according to the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) extraction guideline. RESULTS: We identified 177 vaccine cost-effectiveness analyses (CEAs) between 2009 and 2019 that met the inclusion criteria. Of these, 98 included unintended consequences. Of the total 98 CEAs, overall health consequence categories were included 73 times; biological categories: herd immunity 43 times; pathogen response: resistance 15 times; and cross-protection 15 times. For health consequences pertaining to the supply-side (health systems) categories, side effects were included five times. On the nonhealth demand side (intrahousehold), labor productivity was included 60 times. We identified 29 tuberculosis CEAs from 2009 to 2019 that met the inclusion criteria. Of these, six articles included labor productivity, four included indirect transmission effects, and one included resistance. Between 2009 and 2019, only 34% of tuberculosis CEAs included additional unintended consequences, compared with 55% of vaccine CEAs. CONCLUSIONS: The inclusion of additional unintended consequences in economic evaluations of immunization and tuberculosis continues to be limited. Additional unintended consequences of economic benefits, such as those examined in this review and especially those that occur outside the health system, offer valuable information to analysts. Further work on appropriate ways to value these additional unintended consequences is still warranted.

Analysis of the impact of the Birmingham OwnHealth program on secondary care utilization and cost: a retrospective cohort study.

BACKGROUND: This study aimed to assess the impact of the Birmingham OwnHealth(®) program (a partnership among the National Health Service [NHS] Birmingham East and North, formerly Birmingham East and North PCT, as the commissioner, Pfizer Health Solutions [Tadworth, United Kingdom] as the primary contractor, and NHS Direct as a subcontractor) on the number of unscheduled secondary care spells and the cost of care for patients with long-term conditions. This article reports a retrospective cohort study conducted at the NHS Birmingham East and North. SUBJECTS AND METHODS: Adults with at least 1 of 10 defined long-term conditions were eligible for inclusion. Patients in the OwnHealth program were compared with those in a matched comparison group from a population who were eligible but did not enroll in the program. The main outcome measures were the difference in the number of secondary care spells (defined as the experience between hospital admission and discharge) between the OwnHealth group and the comparison group and the difference in the cost of care (calculated from the cost of activities during secondary care spells). RESULTS: The mean number of secondary care spells per person per year in the OwnHealth group was 0.61 (standard deviation [SD] 1.35) compared with 0.84 (SD 1.49) in the comparison group (p<0.0005). This constituted a 27% reduction in secondary care spells per person per year. The mean cost of secondary care spells per person per year in the OwnHealth group was $1,305 (SD $3,138) compared with $1,678 (SD $3,485) in the comparison group (p<0.0005). DISCUSSION: This difference in costs constituted a 27% reduction in utilization and 22% reduction in cost of secondary care with the OwnHealth program. CONCLUSIONS: Telehealth intervention can reduce the cost of secondary care of some patients with long-term conditions.