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Vaccines for the 21st Century: A Tool for Decisionmaking (2000)
Institute of Medicine (IOM)

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. "Appendix 23: Shigella." Vaccines for the 21st Century: A Tool for Decisionmaking. Washington, DC: The National Academies Press, 2000.

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Vaccines for the 21st Century: A Tool for Decisionmaking

Table A23–1 Health Care Costs Associated with Shigella Infection

 

% of Cases

Cost per Unit

Units per Case

Form of Treatment

Acute diarrhea

25%

$10

2.0

oral rehydration therapy

 

75%

$50

1.0

physician a

75%

$50

1.0

medication b

Using committee assumptions of less-than-ideal efficacy and utilization and including time and monetary costs until a vaccine program is implemented, the annualized present value of the health care costs saved would be $620,000.

If a vaccine program for Shigella were implemented today and the vaccine was 100% efficacious and utilized by 100% of the target population, the annualized present value of the program cost would be $1.2 billion. Using committee assumptions of less-than-ideal efficacy and utilization and including time and monetary costs until a vaccine program is implemented, the annualized present value of the program cost would be $550 million.

Using committee assumptions of time and costs until licensure, the fixed cost of vaccine development has been amortized and is $7.2 million for a Shigella vaccine.

If a vaccine program were implemented today and the vaccine was 100% efficacious and utilized by 100% of the target population, the annualized present value of the cost per QALY gained is $7 million. Using committee assumptions of less-than-ideal utilization and including time and monetary costs until a vaccine program is implemented, the annualized present value of the cost per QALY gained is $9 million. If the vaccine were utilized by 90% of travelers (and no infants) the annualized present value of the cost per QALY gained is $11 million.

See Chapters 4 and 5 for details on the methods and assumptions used by the committee for the results reported.

READING LIST

Ashkenazi S, Cleary TG. Shigella Infections. In: Textbook of Pediatric Infectious Diseases. RD Feigin and JD Cherry eds. Philadelphia, PA: WB Saunder Company, 1992, pp. 637–646.


CDC. Summary of Notifiable Diseases, United States 1994. Morbidity and Mortality Weekly Report 1994; 43:1–80.


DuPont HL. Shigella Species (Bacillary Dysentery). In: Principles and Practice of Infectious Diseases. GL Mandell, JE Bennett, Dolin R eds. New York, NY: Churchill Livingstone, 1995, pp. 2033–2039.

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297
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)