This cost-effectiveness analysis estimates the cost-effectiveness of universal and targeted newborn congenital cytomegalovirus screening programs vs no screening among infants in US postpartum care and early hearing programs.
This randomized clinical trial evaluates the costs and cost-effectiveness of collaborative care vs usual care for treatment of adolescent major depressive disorder in primary care settings.
This simulation study using a mathematical model of pertussis transmission assesses whether a priming dose of whole-cell pertussis vaccine is cost-effective at reducing pertussis infection in infants.
This randomized pragmatic trial reports improved rates of up-to-date immunizations when primary care practices instituted a collaborative centralized reminder/recall. See also the Editorial comment by Fiks.
In a cluster randomized controlled trial, Fottrell and coauthors assess the effect of a participatory women’s group intervention with higher population coverage on neonatal mortality in Bangladesh.
To evaluate the cost-effectiveness of immunoprophylaxis against respiratory syncytial virus (RSV) infections with palivizumab based on actual cost and observed incidence rates in various pediatric risk groups.
Decision tree analysis comparing children with various combinations of the following indications: chronic lung disease, congenital heart disease, or prematurity (≤32 weeks gestation), and children with none of these indications. One-way sensitivity analyses and Monte Carlo simulations were used to quantify parameter uncertainty.
Florida during the 2004-2005 RSV season.
A total of 159 790 Medicaid-eligible children aged 0 to 2 years.
Palivizumab prophylaxis compared with no prophylaxis.
Incremental cost (2010 US dollars) per hospitalization for RSV infection avoided.
The mean cost of palivizumab per dose ranged from $1661 for infants younger than 6 months of age to $2584 for children in their second year of life. Among preterm infants younger than 6 months of age without other indications, immunoprophylaxis with palivizumab cost $302 103 (95% confidence interval, $141 850-$914 798) to prevent 1 RSV-related hospitalization. Given a mean cost of $8910 for 1 RSV-related hospitalization in this subgroup, palivizumab would be cost-neutral at a per-dose cost of $47. Incremental cost-effectiveness ratios for the other subgroups ranged from $361 727 to more than $1.3 million per RSV-related hospitalization avoided in children up to 2 years of age with chronic lung disease and no additional risk factors. Younger age and multiple indications were associated with improvements in the incremental cost-effectiveness ratio.
The cost of immunoprophylaxis with palivizumab far exceeded the economic benefit of preventing hospitalizations, even in infants at highest risk for RSV infection.
To evaluate the effect of adverse events associated with live attenuated influenza vaccine (LAIV) in children younger than 5 years on the cost-effectiveness of influenza vaccination.
A decision analytic model was developed to predict costs and health effects of no vaccination, vaccination with LAIV, and vaccination with inactivated influenza vaccine (IIV). Probabilities, costs, and quality adjustments for uncomplicated influenza, outpatient visits, hospitalizations, deaths, vaccination, and vaccine adverse events were based on primary and published data. The analysis included the possible increased incidence of adverse events following vaccination with LAIV for children younger than 5 years, including fever, wheezing, and hospitalization. A societal perspective was used. Sensitivity analyses, including probabilistic sensitivity analysis, were conducted.
Vaccination in the physician office setting in the United States.
Hypothetical cohorts of healthy children aged 6 months to 4 years.
Vaccination with LAIV or IIV.
Incremental cost-effectiveness ratio in dollars per quality-adjusted life-year (QALY).
Cost-effectiveness ratios ranged from $20 000/QALY (age 6-23 months) to $33 000/QALY (age 3-4 years) for LAIV and from $21 000/QALY to $37 000/QALY for IIV for healthy children aged 6 months to 4 years. Inclusion of possible new adverse events for LAIV had varying effects on cost-effectiveness results. Results were not sensitive to the inclusion of wheezing as an adverse event but were sensitive to a possible increase in the probability of hospitalization.
Live attenuated influenza vaccine had comparable cost-effectiveness compared with IIV for children younger than 5 years under a wide range of assumptions about the incidence of adverse events.