Cost-Effectiveness of Chlamydia Vaccination for Young Women
Cost-Effectiveness of Chlamydia Vaccination for Young Women
We explored potential cost-effectiveness of a chlamydia vaccine for young women in the United States by using a compartmental heterosexual transmission model. We tracked health outcomes (acute infections and sequelae measured in quality-adjusted life-years [QALYs]) and determined incremental cost-effectiveness ratios (ICERs) over a 50-year analytic horizon. We assessed vaccination of 14-year-old girls and catch-up vaccination for 15–24-year-old women in the context of an existing chlamydia screening program and assumed 2 prevaccination prevalences of 3.2% by main analysis and 3.7% by additional analysis. Estimated ICERs of vaccinating 14-year-old girls were $35,300/QALY by main analysis and $16,200/QALY by additional analysis compared with only screening. Catch-up vaccination for 15–24-year-old women resulted in estimated ICERs of $53,200/QALY by main analysis and $26,300/QALY by additional analysis. The ICER was most sensitive to prevaccination prevalence for women, followed by cost of vaccination, duration of vaccine-conferred immunity, and vaccine efficacy. Our results suggest that a successful chlamydia vaccine could be cost-effective.
Chlamydia remains a major public health problem; there were ≈105.7 million new cases of this disease among adults 15–49 years of age worldwide in 2008. In the United States, >1.4 million cases of chlamydial infections were reported to the Centers for Disease Control and Prevention in 2012. A recent study estimated that there were ≈2.8 million cases of chlamydia among all persons of all ages in 2008 and that the estimated direct lifetime cost was >$500 million 2013 US dollars. Most infections in women are asymptomatic, and untreated infections can progress to serious sequelae, such as pelvic inflammatory disease (PID), ectopic pregnancy, tubal infertility, and chronic pelvic pain. In addition, untreated chlamydia may cause serious and costly sequelae, such as urethritis, epididymitis, proctitis, and Reiter syndrome in men.
In this study, we explored the health and economic outcomes of a hypothetical chlamydia vaccine in the United States from a societal perspective. Although there currently is no chlamydia vaccine, the future development of an effective chlamydia vaccine is possible, and support for use of a vaccine for future chlamydia prevention efforts continues to increase. Models of the effect and cost-effectiveness of human papillomavirus (HPV) vaccine were developed before HPV vaccines were approved for use in the United States. These models, as well as subsequent models they helped to inform, proved valuable to public health officials and policy makers. Our exploratory model is intended to help advance the discussion surrounding development of a successful chlamydia vaccine, to inform the business case for investing in research and development of chlamydia vaccines, and to promote development of more detailed models so that the necessary tools are in place for chlamydia vaccine recommendations.
Abstract and Introduction
Abstract
We explored potential cost-effectiveness of a chlamydia vaccine for young women in the United States by using a compartmental heterosexual transmission model. We tracked health outcomes (acute infections and sequelae measured in quality-adjusted life-years [QALYs]) and determined incremental cost-effectiveness ratios (ICERs) over a 50-year analytic horizon. We assessed vaccination of 14-year-old girls and catch-up vaccination for 15–24-year-old women in the context of an existing chlamydia screening program and assumed 2 prevaccination prevalences of 3.2% by main analysis and 3.7% by additional analysis. Estimated ICERs of vaccinating 14-year-old girls were $35,300/QALY by main analysis and $16,200/QALY by additional analysis compared with only screening. Catch-up vaccination for 15–24-year-old women resulted in estimated ICERs of $53,200/QALY by main analysis and $26,300/QALY by additional analysis. The ICER was most sensitive to prevaccination prevalence for women, followed by cost of vaccination, duration of vaccine-conferred immunity, and vaccine efficacy. Our results suggest that a successful chlamydia vaccine could be cost-effective.
Introduction
Chlamydia remains a major public health problem; there were ≈105.7 million new cases of this disease among adults 15–49 years of age worldwide in 2008. In the United States, >1.4 million cases of chlamydial infections were reported to the Centers for Disease Control and Prevention in 2012. A recent study estimated that there were ≈2.8 million cases of chlamydia among all persons of all ages in 2008 and that the estimated direct lifetime cost was >$500 million 2013 US dollars. Most infections in women are asymptomatic, and untreated infections can progress to serious sequelae, such as pelvic inflammatory disease (PID), ectopic pregnancy, tubal infertility, and chronic pelvic pain. In addition, untreated chlamydia may cause serious and costly sequelae, such as urethritis, epididymitis, proctitis, and Reiter syndrome in men.
In this study, we explored the health and economic outcomes of a hypothetical chlamydia vaccine in the United States from a societal perspective. Although there currently is no chlamydia vaccine, the future development of an effective chlamydia vaccine is possible, and support for use of a vaccine for future chlamydia prevention efforts continues to increase. Models of the effect and cost-effectiveness of human papillomavirus (HPV) vaccine were developed before HPV vaccines were approved for use in the United States. These models, as well as subsequent models they helped to inform, proved valuable to public health officials and policy makers. Our exploratory model is intended to help advance the discussion surrounding development of a successful chlamydia vaccine, to inform the business case for investing in research and development of chlamydia vaccines, and to promote development of more detailed models so that the necessary tools are in place for chlamydia vaccine recommendations.
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