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Canadian Journal of Public Health

, Volume 91, Issue 5, pp 334–339 | Cite as

A Cost-effectiveness Analysis of Pneumococcal Vaccination in Street-involved, HIV-infected Patients

  • Carlo A. Marra
  • David M. Patrick
  • Fawziah MarraEmail author
Article

Abstract

Background: Delivery of the pneumococcal vaccine (PCV) to street-involved, HIV patients in British Columbia is low due to poor compliance. Since the use of PCV is expected to reduce morbidity and mortality, it may be more cost-effective to provide the vaccine directly to clinics.

Methods: Three strategies were compared for a cohort of 5000 patients: 1) administering PCV at the clinics; 2) giving a prescription for PCV and expecting patients to fill it at a pharmacy and return for administration; and 3) no administration of vaccine. Decision analysis was utilized to map the costs and outcomes of the patients over 5 years and conduct an incremental cost-effectiveness analysis from the perspective of the Ministry of Health.

Results: The average cost per patient was the lowest in Strategy 1 ($549) compared to Strategy 2 ($702) and Strategy 3 ($714). For the cohort, Strategy 1 prevented 269 and 299 additional cases of pneumococcal disease and resulted in a cost savings of $535,000 and $595,000 in direct medical costs when compared to Strategies 2 and 3, respectively. The model was robust to extensive sensitivity analyses.

Conclusions: The Ministry of Health should supply PCV to clinics involved in the care of street-involved HIV patients as this is the most cost-effective strategy.

Résumé

Contexte: L’administration du vaccin anti-pneumococcique (PCV) aux patients de la rue atteints du VIH, en Colombie-Britannique est faible en raison du manque d’assiduité. Il serait plus rentable de fournir le vaccin directement aux cliniques, étant donné que le vaccin PCV est censé réduire la morbidité et la mortalité.

Méthodes: Nous avons mis trois stratégies à l’épreuve, auprès d’une cohorte de 5 000 patients: 1) administrer le PCV en clinique, 2) remettre une ordonnance pour le vaccin PCV au patient et s’attendre à ce qu’il la fasse compléter à la pharmacie et revienne pour le recevoir, et 3) ne pas administrer le vaccin. L’analyse de décision a servi à établir les coûts et les résultats chez les patients pendant plus de cinq ans et d’effectuer une analyse de rentabilité du point de vue du Ministre de la santé.

Résultats: Le coût moyen par patient était le plus bas dans la première stratégie (549 $) comparativement à 702 $ dans la deuxième et à 714 $ dans la troisième stratégie. Pour ce qui est de la cohorte, la première stratégie a prévenu l’apparition de 269 cas puis de 299 autres cas d’infection pneumococcique, entraînant des économies de 535 000 $ et de 595 000 $ respectivement en coûts médicaux directs si on les compare aux stratégies 2 et 3. Le modèle utilisé était robuste jusqu’à la généralisation de l’analyse de sensibilité.

Conclusions: La stratégie la plus rentable pour le Ministre de la santé devrait consister à alimenter en vaccin PCV les cliniques qui sont impliquées dans les interventions de rue auprès des patients atteints du VIH.

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Copyright information

© The Canadian Public Health Association 2000

Authors and Affiliations

  • Carlo A. Marra
    • 1
    • 2
  • David M. Patrick
    • 3
    • 4
  • Fawziah Marra
    • 5
    • 6
    Email author
  1. 1.Clinical Drug Research Program, Department of PharmacyVancouver Hospital and Health Sciences CentreVancouverCanada
  2. 2.Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverCanada
  3. 3.Division of STD/AIDS ControlB.C. Centre for Disease ControlCanada
  4. 4.Division of Infectious Diseases, Faculty of MedicineUniversity of British ColumbiaCanada
  5. 5.Faculty of Pharmaceutical SciencesUniversity of British ColumbiaCanada
  6. 6.Pharmacotherapeutic Specialist, Infectious Diseases, Department of Pharmacy, Vancouver Hospital and Health Sciences CentreCSU - Pharmaceutical SciencesVancouverCanada

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