Cost-effectiveness of pneumococcal vaccination for older people: a study in five western European countries Ament A, Baltussen R, Duru G, Rigaud-Bully C, De Graeve D, et al, Journal of infectious diseases, Clinical Infectious Diseases, vol 31, nr 2, pp

Is vaccination a valuable preventive strategy? Pneumococcal Pneumonia is a serious threat to our health Treatment of Pneumococcal pneumonia is costly This is especially true in the elderly Vaccination can eliminate part of the clinical and economic consequences of pneumococcal disease But it generates costs as well (vaccine, administration, side-effects…)  Analyse the cost-effectiveness of vaccination

Restriction to invasive disease – Analysis in five countries Much better evidence of clinical protection of the vaccine against invasive disease Information on the cost-effectiveness of vaccination in preventing invasive disease could provide strong support for public policies to provide strong support for public policies to vaccinate older individuals Belgium France, Scotland, Spain and Sweden; same methodology, different data

Characteristics of the evaluation Alternatives compared:  vaccination versus treatment of persons 64+ years Measures of costs and effects  Costs (C): direct medical costs for society in € 1995  Effects (E): number of qualys gained  CE-ratio: C (Vaccination) - C (Treatment ) E (Vaccination) - E (Treatment)

Country-specific, age specific mortality rates Year 1 …year five

BelgiumFranceScotlandSpainSweden Base case † 25,907 ‡ 19,18214,89210,51132,675 Without influenza vaccination43,10637,88623,42220,01357,314 Incidence of disease (cases per 100,000  65 years) 30 / 100,00029,59315,21713,64523,77431, / 100,00021,00310,6339,97517,10121, / 100,00015,8497,8837,77313,09716,240 Mortality (%) 2019,79619,90423,1357,34215, ,19713,26915,4234,89510, ,8989,95111,5663,6717,512 Results of the sensitivity analyses

BelgiumFranceScotlandSpainSweden Base case † 25,907 ‡ 19,18214,89210,51132,675 Vaccine price current price – 3.00 ecus21,67815,17412,1107,77023,875 current price ecus30,13623,19017,67313,25241,474 Vaccination effectiveness § best case17,32812,47310,1276,62220,991 worst case72,86853,28542,05537,276104,209 No quality-of-life adjustment16,30711,8879,2336,44420,017 Discount rate, 0%18,56513,76411,2587,41923,713 Discount rate, 5%31,22023,10917,51112,74739,111 Results of the sensitivity analyses

Conclusions The results support recent recommendations to vaccinate people aged 65 years and older with Pneumococcal P.S. Vaccine Even when only considering invasive disease, this strategy is acceptably to moderately cost- effective (less so for the very old) Very reliable data on incidence and mortality of S. pneumoniae would be good to convince the sceptics