A Cost-Effectiveness Analysis of Pneumococcal Vaccination in Street-Involved, HIV-Infected Patients

By Marra, Carlo A; Patrick, David M et al. | Canadian Journal of Public Health, September/October 2000 | Go to article overview

A Cost-Effectiveness Analysis of Pneumococcal Vaccination in Street-Involved, HIV-Infected Patients


Marra, Carlo A, Patrick, David M, Marra, Fawziah, Canadian Journal of Public Health


ABSTRACT

Background. Delivery of the pneumococcal vaccine (PCV) to street-involved, HIV patients in British Columbia is low due to poor compliance. Since the use of PCV is expected to reduce morbidity and mortality, it may be more costeffective to provide the vaccine directly to clinics.

Methods: Three strategies were compared for a cohort of 5000 patients: 1) administering PCV at the clinics; 2) giving a prescription for PCV and expecting patients to fill it at a pharmacy and return for administration; and 3) no administration of vaccine. Decision analysis was utilized to map the costs and outcomes of the patients over 5 years and conduct an incremental cost-effectiveness analysis from the perspective of the Ministry of Health.

Results: The average cost per patient was the lowest in Strategy 1 ($549) compared to Strategy 2 ($702) and Strategy 3 ($714). For the cohort, Strategy 1 prevented 269 and 299 additional cases of pneumococcal disease and resulted in a cost savings of $535,000 and $595,000 in direct medical costs when compared to Strategies 2 and 3, respectively. The model was robust to extensive sensitivity analyses.

Conclusions: The Ministry of Health should supply PCV to clinics involved in the care of street-involved HIV patients as this is the most cost-effective strategy.

ABREGE

Contexte: L'administration du vaccin antipneumococcique (PCV) aux patients de la rue atteints du VIH, en Colombie-Britannique est faible en raison du manque d'assiduite. It serait plus rentable de fournir le vaccin directement aux cliniques, etant donne que le vaccin PCV est tense reduire la morbidite et la mortalite.

Methodes : Nous avons mis trois strategies a l'epreuve, aupres d'une cohorte de 5 000 patients : 1) administrer le PCV en clinique, 2) remettre une ordonnance pour le vaccin PCV au patient et s'attendre a ce qu'il la false completer at la pharmacie et revienne pour le recevoir, et 3) ne pas administrer le vaccin. L'analyse de decision a servi at etablir les costs et les resultats chez les patients pendant plus de cinq ans et d'effectuer une analyse de rentabilite du point de vue du Ministre de la sante.

Risuultats: Le cout moyen par patient etait le plus bas dans la premiere strategie (.549 $) comparativement a 702 $ dans la deuxieme et a 714 $ dans la troisieme strategie. Pour ce qui est de la cohorte, la premiere strategie a prevenu (apparition de 269 cas puffs de 299 autres cas d'infection pneumococcique, entrainant des economies de 535 000 $ et de 595 000 $ respectivement en coats medicaux directs si on les compare aux strategies 2 et 3. Lc module utilise etait robuste jusqu'a la generalisation de (analyse de sensibilite.

Conclusions: La strategie la plus rentable pour le Ministre de la same devrait consister a alimenter en vaccin PCV les cliniques qui sont impliquees dans les interventions de rue aupris des patients atteints du VIH.

Infections due to Streptococcus pneumoniae remain a major cause of morbidity, mortality and health care expenditure around the world. S. pneumoniae is an important cause of meningitis, otitis media, sinusitis, pneumonia and bacteremia in adults and children. In the developed countries, invasive disease due to S. pneumoniae is a serious problem among the elderly, infants, individuals with chronic underlying conditions or those who are immunosuppressed, including patients infected with the human immunodeficiency virus (HIV).

Pneumonia is the most commonly diagnosed bacterial respiratory infection in HIV-infected persons.' As in the general population, S. pneumoniae is the most common bacterial pathogen identified in these patients with community-acquired pneumonia. Population-based studies suggest that bacterial pneumonia occurs much more commonly among HIV-infected individuals than in the non-HIV-infected population.` The predisposition to invasive pneumococcal disease during HIV infection is due to dysfunctional host defenses rather than increased bacterial exposure or colonization.

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