Economic Evaluation of Routine Childhood Immunization with DTaP, Hib, IPV, MMR and HepB Vaccines in

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Economic Evaluation of Routine Childhood
Immunization with DTaP, Hib, IPV, MMR and HepB
Vaccines in the United States, 2001
Fangjun Zhou Health Services Research and
Evaluation Branch, NIP, CDC
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Collaborators

• Hussain R. Yusuf, MBBS, MPH
• Abigail Shefer, MD
• Lance Rodewald, MD
• Susan Y. Chu, PhD
• Mark Messonnier, PhD
• Jeanne Santoli, MD, MPH

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Background Vaccine-preventable diseases, by year
of vaccine development or licensure United
States
Vaccine developed Vaccine licensed for use
in US
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Recommended Childhood and Adolescent Immunization
ScheduleUnited States, 2003
range of recommended ages
preadolescent assessment
catch-up vaccination
Age
1 mo
2 mos
4 mos
4-6 yrs
6 mos
12 mos
15 mos
18 mos
24 mos
11-12 yrs
13-18 yrs
Vaccine
Birth
HepB 1
only if mother HBsAg ( - )
Hepatitis B1
HepB series
HepB 2
HepB 3
Diphtheria, Tetanus, Pertussis2
DTaP
DTaP
DTaP
DTaP
Td
DTaP
Haemophilus influenzae Type b3
Hib
Hib
Hib
Hib
Inactivated Polio
IPV
IPV
IPV
IPV
Measles, Mumps, Rubella4
MMR 1
MMR 2
MMR 2
Varicella5
Varicella
Varicella
Pneumococcal6
PCV
PCV
PCV
PCV
PCV
PPV
Vaccines below this line are for selected
populations
Hepatitis A7
Hepatitis A series
Influenza8
Influenza (yearly)
This schedule indicates the recommended ages for
routine administration of currently licensed
childhood vaccines, as of December 1, 2002, for
children through age 18 years. Any dose not given
at the recommended age should be given at any
subsequent visit when indicated and feasible.
Indicates age groups that warrant special
effort to administer those vaccines not
previously given. Additional vaccines may be
licensed and recommended during the year.
Licensed combination vaccines may be used
whenever any components of the combination are
indicated and the vaccines other components are
not contraindicated. Providers should consult the
manufacturers' package inserts for detailed
recommendations.
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Estimated U.S. Vaccination Coverage with
Individual Vaccines (19-35 months), 2001
National Immunization Survey 2001
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U.S. Diphtheria Cases1923-2001
2001 data provisional
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U.S. Tetanus Cases1927-2001
2001 data provisional
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U.S. Pertussis Cases1926-2001
2001 data provisional
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U.S. Haemophilus influenzae Type b
Cases1985-2001
2001 data provisional
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U.S. Polio Cases1955-2001
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U.S. Measles Cases1963-2001
2001 data provisional
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U.S. Mumps Cases1968-2001
2001 data provisional
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U.S. Rubella Cases1969-2001
2001 data provisional
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U.S. Hepatitis B Cases1981-2001
2001 data provisional
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Objective

• To evaluate the economic impact of routine
  childhood immunization with DTaP, Hib, IPV, MMR
  and HepB vaccines in the U.S., from direct cost
  and societal perspectives.

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Methods

• Cohort based model
• U.S. birth cohort in 2001
• over the lifetime of the cohort
• Decision tree
• Benefit-cost ratio and net present value of the
  program
• Year 2001 and 3 discount rate

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Simplified Decision Tree
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B/C Ratio and Net Present Value

• Benefit-cost ratio
• Net Present value

Program benefit (costs averted by the program)
divided by program cost, T life time, r
discount rate
Program benefit minus program cost
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Data

• Information was collected on
• Demographics (earnings)
• Vaccination (vaccine, administration, adverse
  events, parents time lost)
• Medical costs for diseases
• Work loss costs (parents time lost, patients
  time)
• Other direct non-medical costs (special
  education)

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Data Sources
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Preliminary Results
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Number of Cases and Deaths
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Direct and Societal Costs
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Prevented or Saved by Immunization Program (One
cohort)
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Summary
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Univariate Sensitivity Analysis
Wastage rate12
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Limitations

• The cost data might not be representative
• Underestimate of benefit
• pain and suffering to family and friends of the
  ill patient not included in our analyses

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Conclusions

• The routine childhood immunization program
  prevents about 10.5 million cases and 33,000
  deaths for one birth cohort
• It is cost saving (in terms of direct costs,
  saves about 10.5 billion, and from societal
  perspective, saves about 42 billion).

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Next Steps

• Validation of the model by external experts
• Disease experts, epidemiologists
• Economists
• Add Varicella and Pneumococcal conjugate vaccines