Costo efectividad de la vacunación contra enfermedad neumocóccica en mayores de 60 años en Colombia Nelson Alvis Guzman PhD

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Evaluación Económica de Vacunas ProVac Center of Excellence

• Es el uso herramientas analíticas para generar evidencia sobre la eficiencia del uso de vacunas que permitan tomar decisiones respecto a asignación de recursos

Análisis marginal ProVac Center of Excellence

Objetivo ProVac Center of Excellence

• Estimar la costo efectividad de la introducción de la vacuna neumocóccica polisacárída 23 valente (PPSV23) en adultos mayores de 60 años en Colombia.

Métodos ProVac Center of Excellence

Se combinaron los siguientes estudios: 1. Revisión sistemática: Estimación de parámetros de epidemiológicos y revisión de costos de la enfermedad 2. Descripción de Costo directos de atención de neumonías y meningitis: Macrocosteo a partir de Registros individuales de Prestación de Servicios (RIPS) desde la perspectiva del Sistema de Salud 3. Análisis de Costo Efectividad: de la PPV23 en > de 60 años.

Fuentes de información ProVac Center of Excellence

• Revisión de la literatura científica nacional e internacional y literatura gris. • Registros Individuales de Prestación de Servicios de Salud (RIPS), para consultas y hospitalizaciones por neumonía y meningitis. • Para neumonías se contabilizaron los diagnósticos correspondientes a los códigos J10 a J18 del CIE 10 y para meningitis los códigos G000 a G039. • Base de datos de Mortalidad de Bogotá 1998 – 2006 • Colombian National Demographic and Health Survey, 2005 (CNDHS)

Parámetros ProVac Center of Excellence

Estimación de Parámetros ProVac Center of Excellence

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Decision Model ProVac Center of Excellence

Assumptions ProVac Center of Excellence

1. Vaccinated people who were not protected by the vaccine had the same chance of being infected than those not vaccinated. 2. The maximum protection for the vaccine occurred after 15 days of the first dose. 3. The probability of occurrence of the categories of pneumonia and meningitis are allocated based on previous estimates of the proportions of cases due to pneumococcal. 4. Only pneumonia and meningitis were included as clinical outcomes of S. Pneumoniae infection. 5. The final states are healing or death. 6. The time horizon was 5 years, 7. Discounted rate of 3%. 8. Main Outcome: Life years gained (LYG).

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Resultados

Burden of pneumococcal disease in over 60 years old, Colombia, (5 years) ProVac Center of Excellence

Burden of pneumococcal disease in over 60 years old, Colombia, (5 years) ProVac Center of Excellence

Cost Without Vaccination ProVac Center of Excellence

Mean estimate Inferior limit

Superior limit

Costs of pneumonias (included pneumococcal invasive)

$ 114,815,745

$ 46,993,688

$ 389,944,375

Costs of Invasive pneumococcal pneumonias

$ 12,055,338

$ 3,383,426

$ 53,423,847

$ 783,882

$389,074

Cost IPD (invasive pneumococcal pneumonias + pneumococcal meningitis)

$ 12,839,220

$ 3,772,500

$ 55,401,556

Total Costs (All pneumonias + pneumococcal meningitis)

$ 115,599,627

$ 47,382,762

$391,922,083

Costs of pneumococcal meningitis

$

1,977,709

Cost With Vaccination ProVac Center of Excellence

Mean estimate

Inferior limit

Superior limit

$23 248 584

$10 378 835

$37 363 800

Costs of pneumonias (included $106 820 102 pneumococcal invasive)

$45 821 666

$337 810 041

Costs of Invasive pneumococcal pneumonias

$7 838 560

$2 706 695

$24 610 005

$497 509

$317 403

$891 608

Total costs (Vaccination plus Burden of disease)

$130,566,196

$56,517,904

$376,065,449

Costs averted

$8,282,016

$1,243,693

$53,220,434

Vaccination costs

Costs of pneumococcal meningitis

ICER ProVac Center of Excellence

Mean estimate

Inferior limit

Superior limit

$1.018

−$403

$2.219

$58.463

−$31.905

$130.502

ICER death averted

$3400

−$1028

$10,862

ICER LYG without discount

$1285

−$408

$4231

ICER LYG with discount

$1514

−$408

$5404

ICER per pneumonia case averted ICER per meningitis case averted

US$4799 (Colombia GDP per capita) 2008

Acceptability curves ProVac Center of Excellence

Vaccination

U$1,500

No Vaccination

US$4799 (Colombia GDP per capita) 2008

Key Drivers ProVac Center of Excellence

Conclusion ProVac Center of Excellence

• This is the first study that assesses the introduction of the PPV- 23 vaccine in a developing country. • The results suggest that the use of the PPV23 vaccine in the Colombian population over 60 years old is a highly cost-effective measure compared to the non vaccination scenario.

Limitations ProVac Center of Excellence

• There are no Colombian data for some of the epidemiological parameters related to the frequency of pneumococcal disease in adults above 60 years. • Important variables, such as the efficacy against allcause pneumonia, incidence of IPD and casefatality ratio are unavailable for Colombia. • Non-inclusion of indirect effects • Non-consideration of antimicrobial resistance.

Mortalidad proporcional ProVac Center of Excellence

2,008

2,009

2,010

Proporción pob > 60 años

9.4%

9.6%

9.8% 10.1% 10.3%

Proporción de muertes > 60 años

61.1%

60.2% 62.1% 63.7% 67.6%

Proporción de muertes por neumonía (todas las causas) > 60 años

67.9%

69.3% 71.6% 72.7% 74.5%

p*: preliminary data DANE 2013. Estadísticas Vitales. http://www.dane.gov.co/daneweb_V09/#twoj_fragment1-4

2,011* 2,012p*

Proporción de muertes por neumonías por todas las causas en > de 60 años ProVac Center of Excellence

76.0% 72.7%

74.0%

71.6%

72.0% 69.3%

70.0% 68.0%

74.5%

67.9%

66.0% 64.0% 62.0% 60.0% 2008

2009

2010

2011p*

Neumonias todas las causas > 60 años

p*: preliminary data DANE 2013. Estadísticas Vitales. http://www.dane.gov.co/daneweb_V09/#twoj_fragment1-4

2012p*

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• Gracias