Cost-effectiveness of a potential prophylactic Helicobacter pylori vaccine in the United States.

Full Abstract

BACKGROUND: Helicobacter pylori vaccines are under development to prevent infection. We quantified the cost-effectiveness of such a vaccine in the United States, using a dynamic transmission model. METHODS: We compartmentalized the population by age, infection status, and clinical disease state and measured effectiveness in quality-adjusted life years (QALYs). We simulated no intervention, vaccination of infants, and vaccination of school-age children. Variables included costs of vaccine, vaccine administration, and gastric cancer treatment (in 2007 US dollars), vaccine efficacy, quality adjustment due to gastric cancer, and discount rate. We evaluated possible outcomes for periods of 10-75 years. RESULTS: H. pylori vaccination of infants would cost $2.9 billion over 10 years; savings from cancer prevention would be realized decades later. Over a long time horizon (75 years), incremental costs of H. pylori vaccination would be $1.8 billion, and incremental QALYs would be 0.5 million, yielding a cost-effectiveness ratio of $3871/QALY. With school-age vaccination, the cost-effectiveness ratio would be $22,137/QALY. With time limited to <40 years, the cost-effectiveness ratio exceeded $50,000/QALY. CONCLUSION: When evaluated with a time horizon beyond 40 years, the use of a prophylactic H. pylori vaccine was cost-effective in the United States, especially with infant vaccination.

Author information

Author/s: Rupnow, Marcia F T (MF); Chang, Alicia H (AH); Shachter, Ross D (RD); Owens, Douglas K (DK); Parsonnet, Julie (J);

Affiliation: Department of Management Science and Engineering, Stanford University, Stanford, California, USA.

Grants: 97FEDO9763 (Agency:PHS HHS)

Journal and publication information

Publication Type: Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.; Research Support, U.S. Gov't, P.H.S.

Journal: The Journal of infectious diseases (J Infect Dis), published in United States. (Language: eng)

Reference: 2009-Oct; vol 200 (issue 8) : pp 1311-7

Dates: Created 2009/09/23; Completed 2009/10/29;

PMID: 19751153, status: MEDLINE (last retrieval date: 10/29/2009, IMS Date: )

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