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Cost-Effectiveness of Vaccination against Invasive Pneumococcal Disease among People 50 through 64 Years of Age: Role of Comorbid Conditions and Race

Jane E. Sisk, PhD; William Whang, MD, MS; Jay C. Butler, MD; Vishnu-Priya Sneller, MBBS, PhD; and Cynthia G. Whitney, MD, MPH
[+] Article and Author Information

From the Mount Sinai School of Medicine and Mailman School of Public Health, Columbia University, New York, New York; Massachusetts General Hospital, Boston, Massachusetts; and Centers for Disease Control and Prevention, Anchorage, Alaska, and Atlanta, Georgia.


Acknowledgments: The authors thank the Centers for Disease Control and Prevention staff, especially Ray Strikas, Walter Williams, and Walter Orenstein, for encouragement and guidance, and James Singleton for data on immunocompromised people; the United Network for Organ Sharing for data on transplant survivors; and Marshall McBean, University of Minnesota, and the Centers for Medicare & Medicaid Services (formerly the Health Care Financing Administration) for data on Medicare payment rates.

Grant Support: This project was supported under a cooperative agreement from the Centers for Disease Control and Prevention through the Association of Schools of Public Health, project number S343-16/16.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Jane E. Sisk, PhD, Department of Health Policy, Mount Sinai School of Medicine, Room 2-34, 1425 Madison Avenue, New York, NY 10029; e-mail, jane.sisk@mssm.edu.

Current Author Addresses: Dr. Sisk: Department of Health Policy, Mount Sinai School of Medicine, Room 2-34, 1425 Madison Avenue, New York, NY 10029.

Dr. Whang: Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114.

Dr. Butler: Centers for Disease Control and Prevention, 4055 Tudor Centre Drive, Anchorage, AK 99508.

Dr. Sneller: Centers for Disease Control and Prevention, 1600 Clifton Road, MS C-61, Atlanta, GA 30333.

Dr. Whitney: Centers for Disease Control and Prevention, 1600 Clifton Road, MS C23, Atlanta, GA 30333.

Author Contributions: Conception and design: J.E. Sisk, J.C. Butler, V.-P. Sneller.

Analysis and interpretation of the data: J.E. Sisk, W. Whang, J.C. Butler, V.-P. Sneller, C.G. Whitney.

Drafting of the article: J.E. Sisk.

Critical revision of the article for important intellectual content: J.E. Sisk, W. Whang, J.C. Butler, V.-P. Sneller, C.G. Whitney.

Final approval of the article: J.E. Sisk, W. Whang, J.C. Butler, V.-P. Sneller, C.G. Whitney.

Provision of study materials or patients: J.C. Butler, V.-P. Sneller, C.G. Whitney.

Statistical expertise: W. Whang.

Obtaining of funding: J.E. Sisk, V.-P. Sneller.

Administrative, technical, or logistic support: J.E. Sisk, J.C. Butler, V.-P. Sneller.

Collection and assembly of data: J.E. Sisk, W. Whang, C.G. Whitney.


Ann Intern Med. 2003;138(12):960-968. doi:10.7326/0003-4819-138-12-200306170-00007
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These results support the current recommendation of the Advisory Committee on Immunization Practices for vaccination of high-risk people 50 through 64 years of age; vaccination both saved medical costs and improved health under the most reasonable assumptions. The findings are especially compelling for high-risk black people, who have much lower vaccination rates than others: 12.5% versus 26.7% for all at high risk in the age group. Given the higher incidence of disease among black people, this group gained about twice the health benefits as others. Although vaccinating any high-risk person saved medical costs, vaccinating high-risk black people saved more than four times the savings from vaccinating other high-risk people.

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Figure.
Markov decision model.QALYs

The diagram represents the three states of health in the model used for the decision and cost-effectiveness analysis: invasive pneumococcal disease, average health, and dead. A person in the general immunocompetent population or high-risk population in average health for the respective group enters at the left, at the decision node, to become vaccinated or remain unvaccinated. Each cohort is assumed to make up the entire population and is effectively infinite. Progressing to the right, the vaccinated and unvaccinated cohorts face different probabilities of incurring invasive pneumococcal disease, contingent on vaccination status, and death, conditional on disease status. A person who incurs invasive pneumococcal disease has a lower quality of life during the illness, assumed to last 34 days (National Center for Health Statistics, National Health Interview Survey. Unpublished data, 1993), and a risk for death from invasive pneumococcal disease but has average health and quality of life for the person's age group for the rest of that year. The model assumes that a person who survives invasive pneumococcal disease in 1 year has the same (average) probability of incurring invasive pneumococcal disease in subsequent years. The model incorporates a 1-year cycle to reflect that the data, including the probability of incurring invasive pneumococcal disease, the probability of dying, the effectiveness of vaccination, and the discount rate, were based on 1-year periods. After 6 years, the assumed duration of vaccination protection, both cohorts face the same risks for invasive pneumococcal disease, average health, and death. The analysis sums and discounts net medical costs and quality-adjusted life-years ( ) to derive the cost-effectiveness ratio.

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Summary for Patients

Cost-Effectiveness of Pneumococcal Vaccine for People 50 through 64 Years of Age

The summary below is from the full report titled “Cost-Effectiveness of Vaccination against Invasive Pneumococcal Disease among People 50 through 64 Years of Age: Role of Comorbid Conditions and Race.” It is in the 17 June 2003 issue of Annals of Internal Medicine (volume 138, pages 960-968). The authors are J.E. Sisk, W. Whang, J.C. Butler, V.-P. Sneller, and C.G. Whitney.

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