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Dr Caroline Trotter @ MRF's Meningitis & Septicaemia in Children & Adults 2017

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Cost Effectiveness of GBS vaccination

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Dr Caroline Trotter @ MRF's Meningitis & Septicaemia in Children & Adults 2017

  1. 1. COST-EFFECTIVENESS OF GBS VACCINATION Caroline Trotter clt56@cam.ac.uk
  2. 2. CONTRIBUTORS Dr Kyriaki Giorgakoudi Professor Paul Heath Dr Catherine O’Sullivan Dr Theresa Lamagni Ms Hilary Rattue Dr Mary Ramsay Dr Shamez Ladhani Dr Hareth al-Janabi We thank for funding
  3. 3. OUTLINE •What/ why cost-effectiveness? •UK perspective and cost-effectiveness analysis •Global perspective
  4. 4. WHAT IS COST-EFFECTIVENESS? A cost-effectiveness analysis (CEA) compares the costs and health effects of an intervention to assess the extent to which it can be regarded as providing “value for money”. How can we buy the most health with our NHS money?
  5. 5. COST-EFFECTIVENESS ANALYSIS Slide courtesy of Dr Hannah Christensen Incremental effects of intervention £ per unit of effect Incremental cost of intervention Quality adjusted life years (QALYs) gained through vaccinating Cost of vaccination - cost saved from preventing cases =
  6. 6. JCVI PERSPECTIVE Vaccine decision makers must consider evidence on cost- effectiveness  alongside evidence on safety, immunogenicity, efficacy, disease burden, indirect effects  If a recommended vaccine programme is shown to be cost-effective, DH obliged to implement In principle follow NICE rules  Some specific guidelines for vaccination, such as on uncertainty  Takes perspective of health service (not society)
  7. 7. THE CASE FOR A GBS VACCINE IN THE UK GBS is an important cause of invasive disease in neonates with ~750 cases each year in the UK, 5-10% case fatality, high rate of adverse neurodevelopmental outcomes in survivors Current prevention = risk based intrapartum antibiotic prophylaxis (IAP) Universal screening an alternative but primary prevention through vaccination has greater potential to prevent invasive disease (in neonates and mothers) Need to avoid excessive antibiotic use in context of AMR
  8. 8. MATERNAL IMMUNISATION Pertussis and influenza currently offered to pregnant women in UK Tetanus vaccine widely used in pregnancy globally Buoyant landscape with maternal vaccines in development for a range of infections including RSV and GBS
  9. 9. GBS VACCINES IN DEVELOPMENT A range of vaccines are in development (Heath PT, Vaccine 2016) Leading candidates are protein-polysaccharide conjugates  Trivalent conjugate vaccine has completed phase I and II trials  Now reformulated to pentavalent  An alternative approach is targeting surface expressed proteins, in an attempt to confer broad protection across all serotypes Licensure may require efficacy trials or be based on serological correlates of protection  next talk!
  10. 10. DECISION TREE We concentrate on these outcomes in primary analysis AND include maternal disease. We include stillbirth and prematurity prevention in scenario analyses
  11. 11. PRIMARY DATA SOURCES Neonatal disease Maternal disease Health costs Vaccine costs Incidence and case fatality from latest BPSU study (O’Sullivan et al, submitted) HES data linked to laboratory confirmed cases (PHE) NHS reference costs Vaccine delivery costs from other maternal immunisation programmes Long term disease outcomes from MRF-funded follow-up study Literature Unit costs of health and social care Vaccine cost per dose unknown so threshold cost investigated Literature Literature, especially Schroeder et al. Eur J Health Econ (2009)
  12. 12. BASE CASE SCENARIO EOD 0.58/ 1000 livebirths, 4.4% CFR, 5.5% /9.6% severe/ moderate sequelae, acute healthcare costs ~£12,000 LOD 0.39/ 1000 livebirths, 7.6% CFR, 5.3% / 9.2% severe/ moderate sequelae, acute healthcare costs ~£12,000 Maternal disease 0.27/1,000 maternities, acute healthcare costs ~£2500 Potential adverse effects of vaccination and litigation costs paid by the NHS were included. Vaccine covers 5 serotypes (96%) is 85% effective with 60% uptake, 1 dose required each pregnancy
  13. 13. IMPACT ON DISEASE In the base case scenario, in one year, maternal GBS immunisation will prevent: •369 cases of GBS among infants • Including 179 cases with sequelae. • And 21 infant deaths •103 maternal cases will also be avoided. •In total, 795 life years and 870 QALYs will be gained.
  15. 15. UNCERTAINTY ANALYSIS £20,000 per QALY £30,000 per QALY
  16. 16. SUMMARY OF UK STUDY GBS vaccination is likely to be a cost-effective intervention for the prevention of invasive neonatal and maternal GBS disease + Many parameters are based on recent, high quality studies. - The costs of aftercare for survivors with sequelae are not well defined. These results should encourage manufacturers, especially in context of global interest in the development of GBS vaccines
  17. 17. GLOBAL PERSPECTIVE Major effort to quantify global GBS disease burden “A maternal vaccine with 80% efficacy and 90% coverage could prevent 107000 (UR, 20000–198000) stillbirths and infant deaths” South African CEA concluded “Vaccination would substantially reduce the burden of infant GBS disease in South Africa and would be very cost-effective by WHO guidelines” Kim et al 2014
  18. 18. CONCLUSIONS Cost-effectiveness analyses support development and implementation of GBS vaccines In the UK the current analyses suggest a reasonably high threshold price More work to be done to define cost-effectiveness in lower and middle income countries but new burden of disease studies are a big asset