Cost-effectiveness: routine vaccination – adolescent females against cytomegalovirus

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 30, Issue 27 pp. 3983-4122 (8 June 2012)

Regular Papers
Cost-effectiveness of routine vaccination of adolescent females against cytomegalovirus
Original Research Article
Pages 4060-4066
Amanda F. Dempsey, Heidi M. Pangborn, Lisa A. Prosser

Abstract
Background
Congenital cytomegalovirus (CMV) infection is associated with significant infant morbidity and mortality. A prophylactic vaccine to prevent congenital CMV infection is expected to be available in the near future, and will likely be targeted to adolescent females.

Methods
Using a decision tree, we compared the costs, potential clinical impacts, and cost-effectiveness of the current strategy of no CMV vaccination versus a strategy where all adolescent females are vaccinated against CMV prior to their first pregnancy. Both maternal outcomes related to vaccination, and infant outcomes related to congenital CMV infection, were considered in the model.

Results
Under base-case conditions, our analysis suggested that vaccinating all adolescent females against cytomegalovirus would be both less costly and with greater clinical benefits than not vaccinating. Among a population of 100,000 adolescent females, the vaccination strategy cost $32.3 million dollars less than not vaccinating, and avoided substantial numbers of infants affected with hearing loss, vision loss, and mental retardation, and 8 infant deaths. Our model was most sensitive to variations in vaccine efficacy. When vaccine efficacy against disease was less than 61%, not vaccinating became the preferred strategy because it was less expensive than vaccinating, without substantial changes in clinical benefits to the population.

Conclusions
Under a wide variety of conditions, universal vaccination of adolescent females to protect their future children against congenital CMV infection was cost effective. However, for this to be preferred over not vaccinating, our results suggest that vaccine efficacy against disease would need to be at least 61%.