Table 7 Cost-effectiveness and cost-utility analyses of vaccination programs in the general population

Country

France

Guyana

Slovakia

USA

Netherlands

Year

1978

1998

2001

2004

2010

WB income group

High

Upper-middle

High

High

High

Comparators

1. Vaccinate 13-yr-olds and women

1. Rubella eradication campaign

1. National vaccination campaign

1. Rubella vaccination program

1. Screen and vaccinate all unvaccinated in LVR

2. No vaccination

2. No campaign

2. No campaign

2. No vaccination program

2. Screen and vaccinate all pregnant in LVR

3. Screen and vaccinate all unvaccinated in NL

Perspective

Payer*

NR

Payer

Societal

Payer

Cost components measured

Vaccination; specialist training; research; antenatal supervision; improvement of obstetric care; intensive care

NR

NR**

Vaccination; OP care; hospitalization; institutional care; special care; Indirect (premature mortality, disability, missed work)

Vaccination; screening; healthcare costs

Method of cost estimation

Top-down costing

NR

NR**

Micro-costing; Human capital approach (indirect costs)

Micro-costing

Time period for costs and benefits

15 years

5 years

NR**

40 years

16 years

Discounting (Rate)

Yes (NR)

NR

NR**

Yes (3%)

Yes (4%)

Outcomes

Mortality; lives saved

CRS cases prevented

Rubella cases prevented

Cases prevented; lives saved

QALYs

Method of outcome measurement

Primary analysis of program data

NR

NR**

Decision model

Model-based

Results—ICER (2012 US$/Outcome)

$20,474/Life saved

$3,335/CRS case prevented

$313/Case prevented

Vaccination program was dominant

1 dominated 2; the ICER comparing 3 to 1 was $114,575/QALY gained

Stated conclusion

The immunization program was cost-effective

Rubella eradication is highly cost-effective

National MMR immunization program was cost-effective

Two-dose MMR vaccination program is cost-effective

Screening and vaccinating all unvaccinated women is the most cost-effective

QHES score

30

NS

NS

93

62

Sponsor

NR

NR

NR

CDC

NL CIDC