Vaccines for the 21st Century: A Tool for Decisionmaking

TABLE 5–2 Examples of Health Care Cost Estimates Used

Outpatient Costs
Physician A	$50
Physician B (specialist)	$100
Physician C (in hospital)	$150
Medication A (nonprescription)	$10
Medication B (inexpensive prescription)	$50
Medication C (expensive prescription)	$150
Diagnostic A	$50
Diagnostic B	$100
Diagnostic C	$500
Hospitalization Costs (per admission; based on hospitalization)
Multiple Sclerosis	$3,000
Pneumonia	$3,000
Viral Meningitis	$3,000
Tuberculosis	$6,000
Cellulitis	$3,000
Amputation	$7,000
Cirrhosis	$5,000
Ectopic Pregnancies	$3,000
Ulcer	$3,000
Digestive	$4,000
Gastroenteritis	$2,000
Complicated delivery (additional cost)	$2,000
Infectious myocarditis	$3,000
Diabetic complications	$3,000
Melanoma	$4,000

The total discounted cost of care that would be averted with vaccine use, C_C in Equation 1, was obtained by summing the costs across all health states. As was done for health benefits, calculations for separate subpopulations were summed to produce an estimate of total costs.

VACCINE EFFICACY AND UTILIZATION

The analysis includes adjustments for incomplete efficacy and use of the candidate vaccines, either of which will reduce the expected health benefits and savings in the cost of care. A lower utilization rate will also reduce the costs ssociated with vaccinating the target population. These adjustments were made by multiplying the QALY and cost measures by the assumed efficacy (Eff) and utilization rates (U) (see Equation 2).

Table of Contents

Front Matter R1-R12

Executive Summary 1-10

Introduction 11-16

Progress in Vaccine Development 17-38

Considerations of Candidate Vaccines 39-52

Overview of Analytic Approach and Results 53-92

Review of the Analytical Model 93-108

Ethical Considerations and Caveats 109-122

Observations 123-132

References 133-142

Appendix 1: Borrelia burgdorferi 143-148

Appendix 2: Chlamydia 149-158

Appendix 3: Coccidioides Immitis 159-164

Appendix 4: Cytomegalovirus 165-172

Appendix 5: Enterotoxigenic E. coli 173-176

Appendix 6: Epstein-Barr Virus 177-180

Appendix 7: Helicobacter pylori 181-188

Appendix 8: Hepatitis C 189-194

Appendix 9: Herpes Simplex Virus 195-206

Appendix 10: Histoplasma capsulatum 207-212

Appendix 11: Human Paillomavirus 213-222

Appendix 12: Influenza A and B 223-232

Appendix 13: Insulin-Dependent Diabetes Mellitus 233-238

Appendix 14: Melanoma 239-244

Appendix 15: Multiple Sclerosis 245-250

Appendix 16: Mycobacterium tuberculosis 251-256

Appendix 17: Neisseria gonnorrhea 257-266

Appendix 18: Neisseria meningitidis 267-272

Appendix 19: Parainfluenza Virus 273-278

Appendix 20: Respiratory Syncytial Virus 279-284

Appendix 21: Rheumatoid Arthritis 285-290

Appendix 22: Rotavirus 291-294

Appendix 23: Shigella 295-298

Appendix 24: Streptococcus, Group A 299-304

Appendix 25: Streptococcus, Group B 305-312

Appendix 26: Streptococcus pneumoniae 313-322

Appendix 27: Information on accessing Electronic Spreadsheets 323-324

Appendix 28: Summary of Workshops 325-434

Appendix 29: Questions Posed to Outside Experts and List of Responders 435-442

Index 443-460

VACCINE EFFICACY AND UTILIZATION