Does the Vaccination against Tick-Borne Encephalitis Offer Good Value for Money for Incidence Rates below the WHO Threshold for Endemicity? A Case Study for Germany
Abstract
:1. Introduction
2. Materials and Methods
2.1. General Model Settings
2.2. Model Structure
2.3. Base Case Inputs
2.4. Vaccination
2.5. Health Utility (HU) Estimates
2.6. Cost Estimates
2.7. Analysis
3. Results
3.1. Base Case Results
3.2. Incidence Threshold Analysis
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Health State | Definition | Source |
---|---|---|
Susceptible | No present TBE infection. | |
TBE 1 | Primarily meningeal symptoms including fever, headache, rigidity of the neck, and nausea. | [21,22] |
TBE 2 | Disease with monofocal symptoms of the CNS and/or moderate diffuse brain dysfunction. | [21,22] |
TBE 3 | Disease with multifocal symptoms of the CNS and/or severe diffuse brain dysfunction. | [21,22] |
Inpatient non-CNS TBEv | TBEv cases without CNS manifestation in inpatient care. These infections are usually accompanied by unspecific, flu-like symptoms. | [6,21] |
Outpatient non-CNS TBEv | TBEv cases without CNS manifestation in outpatient care. These infections are usually accompanied by unspecific, flu-like symptoms. | [6] |
TBE death | Death due to TBE | [4,15,17,18] |
Mild sequelae | Presence of one or more mild symptoms, including dizziness, memory deficits, headache, tiredness, slight hearing impairment, minor psychological problems, or unsteady gait. Daily life and working abilities are not markedly affected. | [24] |
Moderate sequelae | Presence of many or more severe symptoms, ataxia of gait, paresis of the extremities, pronounced dementia, or severe deafness. Patient affected in daily life and working ability. | [24] |
Severe sequelae | More pronounced clinical disabilities, often seriously affecting social life and working capabilities, and in a few cases, requiring institutional care. | [24] |
Recovered and immune | Recovered from TBE without any sequelae. Immunity persists for the remainder of the model. | |
All-cause death | All-cause death, based on age- and gender-stratified data extracted from national life and death tables. |
Input Parameter | Base Case Value | Reference |
---|---|---|
Population | ||
Population by age and gender 2022 | Age- and gender-specific | [28] |
Epidemiology | ||
Age-specific incidence rate—average from 2018 to 2022 | Age- and gender-specific | [25] |
Uptake | ||
Proportion of people receiving primary immunization: completion of three doses | 0.19 | [29] |
Vaccine effectiveness | ||
VE for first three years | 0.966 | [10] |
Annual waning rate starting in year four | 0.05 | Expert assumption |
Transition rates | ||
Probability of TBE death | 0.008 | [21] |
Probability of all-cause death—age-specific lifetables 2021 | Age- and gender-specific | [27] |
Proportion of patients suffering from non-CNS TBEv (inpatient setting), among reported cases | 0.25 | [21] |
Additional non-CNS TBEv (outpatient setting), as a proportion of reported cases | 0.15 | Expert assumption |
Probability of TBE 1 | 0.436 | [21] |
Probability of TBE 2 | 0.436 | [21] |
Probability of TBE 3 | 0.128 | [21] |
Probability of developing lifelong sequelae (Sequelae were classified as “mild”, “moderate”, or “severe”, depending on their influence on the patient’s quality of life, following [24]). | 0.538 | [21] |
Mild sequelae | 0.436 | [21] |
Moderate sequelae | 0.444 | [21] |
Severe sequelae | 0.120 | [21] |
Cost parameter Country-adjusted cost value (value in original publication) | ||
Cost of vaccination (per dose) | EUR 50.12 | [30] |
Administration costs | EUR 8.62 (EUR 7.90) | [20] |
Direct medical annual costs per TBE 1 case | EUR 1627.58 (EUR 1235.00) | [18] |
Direct medical annual costs per TBE 2 case | EUR 3841.62 (EUR 2915.00) | [18] |
Direct medical annual costs per TBE 3 case | EUR 14,628.48 (EUR 11,100.00) | [18] |
Direct medical annual costs, mild sequelae | EUR 98.69 (EUR 70.00) | [18] |
Direct medical annual costs, moderate sequelae | EUR 172.00 (EUR 122.00) | [18] |
Direct medical annual costs, severe sequelae | EUR 41,589.27 (EUR 28,952.00) | [18] |
Direct medical costs, non-CNS TBE (inpatient setting) | EUR 2229.81 (EUR 2033.00) | [31] |
Direct medical costs, non-CNS TBE (outpatient setting) | EUR 284.90 (EUR 259.75) | [31] |
Discounting | ||
Discount rate (costs) | 0.030 | [32] |
Discount rate (health utility) | 0.030 | [32] |
Utility values | ||
Utility, TBE 1 | 0.39 × 0.0137 years (duration of 5 days) | [33] |
Utility, TBE 2 | 0.24 × 0.0055 years + 0.28 × 0.0137 years (duration of 7 days) | [33] |
Utility, TBE 3 | 0.24 × 0.0055 years + 0.28 × 0.0137 years (duration of 7 days) | [33] |
Utility, non-CNS TBE (inpatient setting) | 0.495 × 0.0137 years (duration of 5 days) | [34] |
Utility, non-CNS TBE (outpatient setting) | 0.495 × 0.0137 years (duration of 5 days) | [34] |
Utility, mild sequelae | 0.023 | [35] |
Utility, moderate sequelae | 0.160 | [35] |
Utility, severe sequelae | 0.629 | [35] |
Base Case Assumptions Strategies 1 + 2 | Variation in Scenario Analysis | |
---|---|---|
Uptake of primary vaccination | 0.19 | 0.40 |
Yearly waning rate | 0.05 | 0.008 |
Inclusion of outpatient non-CNS cases | 0 | 0.15 |
Multiplier to account for under-ascertainment | No | 0.3 |
Discount rate HU | 0.03 | 0.015 |
Vaccination Strategy | Vaccination Strategy 1 | Vaccination Strategy 2 |
---|---|---|
Target group | Population of ≥1–85 years | Population of ≥60–85 years |
Base case averted TBE cases (hospitalized, CNS involvement) | 1842 | 310 |
Base case gained QALYs | 10,318 | 9125 |
Base case cost per QALY gained in EUR | EUR 253,529 | EUR 82,358 |
VE for first three years 0.937 | EUR 254,891 | EUR 82,499 |
Uptake rate primary immunization 0.40 | EUR 459,805 | EUR 167,155 |
Waning 0.008 | EUR 230,970 | EUR 81,475 |
Under ascertainment 0.3 | EUR 193,144 | EUR 62,918 |
Inclusion of non-CNS TBEv cases (outpatient setting)/rate 0.15 | EUR 253,502 | EUR 82,355 |
Discounting HU 0.015 | EUR 136,337 | EUR 43,981 |
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Müller, M.; Lintener, H.; Henkel, V.; Pilz, A.; Halsby, K.; Malerczyk, C.; Madhava, H.; Moïsi, J.C.; Yu, H.; Schley, K. Does the Vaccination against Tick-Borne Encephalitis Offer Good Value for Money for Incidence Rates below the WHO Threshold for Endemicity? A Case Study for Germany. Vaccines 2024, 12, 1165. https://doi.org/10.3390/vaccines12101165
Müller M, Lintener H, Henkel V, Pilz A, Halsby K, Malerczyk C, Madhava H, Moïsi JC, Yu H, Schley K. Does the Vaccination against Tick-Borne Encephalitis Offer Good Value for Money for Incidence Rates below the WHO Threshold for Endemicity? A Case Study for Germany. Vaccines. 2024; 12(10):1165. https://doi.org/10.3390/vaccines12101165
Chicago/Turabian StyleMüller, Malina, Hannah Lintener, Vivien Henkel, Andreas Pilz, Kate Halsby, Claudius Malerczyk, Harish Madhava, Jennifer C. Moïsi, Holly Yu, and Katharina Schley. 2024. "Does the Vaccination against Tick-Borne Encephalitis Offer Good Value for Money for Incidence Rates below the WHO Threshold for Endemicity? A Case Study for Germany" Vaccines 12, no. 10: 1165. https://doi.org/10.3390/vaccines12101165