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Fangjun Zhou Health Services Research and Evaluation Branch, NIP, CDC

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. Collaborators. Hussain R. Yusuf, MBBS, MPH Abigail Shefer, MD Lance Rodewald, MD

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Fangjun Zhou Health Services Research and Evaluation Branch, NIP, CDC

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

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

  3. Background Vaccine-preventable diseases, by year of vaccine development or licensure – United States * Vaccine developed ** Vaccine licensed for use in US

  4. Recommended Childhood and Adolescent Immunization Schedule—United States, 2003 range of recommended ages catch-up vaccination preadolescent assessment Age 1 mo 2 mos 4 mos 6 mos 12 mos 15 mos 18 mos 24 mos 4-6 yrs 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 DTaP Td 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 vaccine’s other components are not contraindicated. Providers should consult the manufacturers' package inserts for detailed recommendations.

  5. Estimated U.S. Vaccination Coverage with Individual Vaccines (19-35 months), 2001* *National Immunization Survey 2001

  6. U.S. Diphtheria Cases1923-2001* *2001 data provisional

  7. U.S. Tetanus Cases1927-2001* *2001 data provisional

  8. U.S. Pertussis Cases1926-2001* *2001 data provisional

  9. U.S. Haemophilus influenzae Type b Cases1985-2001* *2001 data provisional

  10. U.S. Polio Cases1955-2001

  11. U.S. Measles Cases1963-2001* *2001 data provisional

  12. U.S. Mumps Cases1968-2001* *2001 data provisional

  13. U.S. Rubella Cases1969-2001* *2001 data provisional

  14. U.S. Hepatitis B Cases1981-2001* *2001 data provisional

  15. 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.

  16. 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

  17. Simplified Decision Tree

  18. 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

  19. 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)

  20. Data Sources

  21. Preliminary Results

  22. Number of Cases and Deaths

  23. Direct and Societal Costs

  24. Prevented or Saved by Immunization Program (One cohort)

  25. Summary

  26. Univariate Sensitivity Analysis *Wastage rate=12%

  27. 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

  28. 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).

  29. Next Steps … • Validation of the model by external experts • Disease experts, epidemiologists • Economists • Add Varicella and Pneumococcal conjugate vaccines

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