Cost-effectiveness analysis of maternal immunisation against group B Streptococcus (GBS) disease: A modelling study.
Authors
Giorgakoudi, Kyriaki
O'Sullivan, Catherine
Heath, Paul T
Ladhani, Shamez
Lamagni, Theresa
Ramsay, Mary
Al-Janabi, Hareth
Publication Date
2018-11-12Journal Title
Vaccine
ISSN
0264-410X
Publisher
Elsevier BV
Volume
36
Issue
46
Pages
7033-7042
Language
eng
Type
Article
Physical Medium
Print-Electronic
Metadata
Show full item recordCitation
Giorgakoudi, K., O'Sullivan, C., Heath, P. T., Ladhani, S., Lamagni, T., Ramsay, M., Al-Janabi, H., & et al. (2018). Cost-effectiveness analysis of maternal immunisation against group B Streptococcus (GBS) disease: A modelling study.. Vaccine, 36 (46), 7033-7042. https://doi.org/10.1016/j.vaccine.2018.09.058
Abstract
BACKGROUND: There is a considerable global burden of invasive group B streptococcal (GBS) disease. Vaccines are being developed for use in pregnant women to offer protection to neonates. OBJECTIVE: To estimate the potential impact and cost-effectiveness of maternal immunisation against neonatal and maternal invasive GBS disease in the UK. METHODS: We developed a decision-tree model encompassing GBS-related events in infants and mothers, following a birth cohort with a time horizon equivalent to average life expectancy (81 years). We parameterised the model using contemporary data from disease surveillance and outcomes in GBS survivors. Costs were taken from NHS sources and research studies. Maternal immunisation in combination with risk-based intrapartum antibiotic prophylaxis (IAP) was compared to the current standard practice of risk-based IAP alone from an NHS and Personal Social Services (health-provider) perspective. We estimated the cases averted and cost per QALY gained through vaccination. One-way sensitivity analysis, scenario analysis and probabilistic sensitivity analysis were performed. RESULTS: An effective maternal immunisation programme could substantially reduce the burden of GBS disease. The deterministic analysis estimated the threshold cost-effective price for a GBS vaccine to be £54 per dose at £20,000/QALY (£71 per dose at £30,000/QALY). Results were most sensitive to assumptions on disease incidence, sequelae rate and vaccine efficacy. Probabilistic analysis showed 90.66% of iterations fell under the £30,000 threshold at a vaccine price of £55. Inclusion of modest prevention of stillbirths and/or, preterm births, carer health impacts, maternal GBS deaths and 1.5% discounting improved cost-effectiveness compared to the base case. Lowering vaccine strain coverage made the vaccine less cost-effective. A key limitation is that the properties of the final GBS vaccine are unknown. CONCLUSIONS: Maternal GBS immunisation is expected to be cost-effective, even at a relatively high vaccine price.
Keywords
Humans, Streptococcus agalactiae, Streptococcal Infections, Streptococcal Vaccines, Incidence, Models, Statistical, Pregnancy, Adolescent, Adult, Aged, Aged, 80 and over, Middle Aged, Child, Child, Preschool, Infant, Infant, Newborn, Cost-Benefit Analysis, Female, Young Adult, United Kingdom, Neonatal Sepsis
Sponsorship
Meningitis Research Foundation
Funder references
Meningitis Research Foundation (CH/LG/GC 13020)
Identifiers
External DOI: https://doi.org/10.1016/j.vaccine.2018.09.058
This record's URL: https://www.repository.cam.ac.uk/handle/1810/285533
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