Cost-effectiveness of maternal immunization against neonatal invasive Group B Streptococcus in the Netherlands |
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| Institution: | 1. Athena Institute, VU Amsterdam, the Netherlands;2. National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control (Cib), Bilthoven, the Netherlands;3. Amsterdam UMC, University of Amsterdam, Department of Neurology, the Netherlands;4. Amsterdam UMC, Department of Medical Microbiology, Infection and Immunity, and Netherlands Reference Laboratory for Bacterial Meningitis, Amsterdam, the Netherlands.;5. Amsterdam UMC, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands |
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| Abstract: | BackgroundNeonatal invasive Group B Streptococcus (GBS) infection causes considerable disease burden in the Netherlands. Intrapartum antibiotic prophylaxis (IAP) prevents early-onset disease (EOD), but has no effect on late-onset disease (LOD). A potential maternal GBS vaccine could prevent both EOD and LOD by conferring immunity in neonates.ObjectiveExplore under which circumstances maternal vaccination against GBS would be cost-effective as an addition to, or replacement for the current risk factor-based IAP prevention strategy in the Netherlands.MethodsWe assessed the maximum cost-effective price per dose of a trivalent (serotypes Ia, Ib, and III) and hexavalent (additional serotypes II, IV, and V) GBS vaccine in addition to, or as a replacement for IAP. To project the prevented costs and disease burden, a decision tree model was developed to reflect neonatal GBS disease and long-term health outcomes among a cohort based on 169,836 live births in the Netherlands in 2017.ResultsUnder base-case conditions, maternal immunization with a trivalent vaccine would gain 186 QALYs and prevent more than €3.1 million in health care costs when implemented in addition to IAP. Immunization implemented as a replacement for IAP would gain 88 QALYs compared to the current prevention strategy, prevent €1.5 million in health care costs, and avoid potentially ~ 30,000 IAP administrations. The base-case results correspond to a maximum price of €58 per dose (vaccine + administration costs; using a threshold of €20,000/QALY). Expanding the serotype coverage to a hexavalent vaccine would only have a limited additional impact on the cost-effectiveness in the Netherlands.ConclusionsA maternal GBS vaccine could be cost-effective when implemented in addition to the current risk factor-based IAP prevention strategy in the Netherlands. Discontinuation of IAP would save costs and prevent antibiotic use, however, is projected to lead to a lower health gain compared to vaccination in addition to IAP. |
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| Keywords: | Neonatal disease Cost-effectiveness Intrapartum antibiotic prophylaxis (IAP) Maternal Immunization Vaccine CSF"} {"#name":"keyword" "$":{"id":"k0040"} "$$":[{"#name":"text" "_":"cerebrospinal fluid DALY"} {"#name":"keyword" "$":{"id":"k0050"} "$$":[{"#name":"text" "_":"disability-adjusted life year EOD"} {"#name":"keyword" "$":{"id":"k0060"} "$$":[{"#name":"text" "_":"early-onset disease GBS"} {"#name":"keyword" "$":{"id":"k0070"} "$$":[{"#name":"text" "$$":[{"#name":"__text__" "_":"Group B "} {"#name":"italic" "_":"Streptococcus HUI"} {"#name":"keyword" "$":{"id":"k0080"} "$$":[{"#name":"text" "_":"Health Utilities Index IAP"} {"#name":"keyword" "$":{"id":"k0090"} "$$":[{"#name":"text" "_":"intrapartum antibiotic prophylaxis ICU"} {"#name":"keyword" "$":{"id":"k0100"} "$$":[{"#name":"text" "_":"intensive care unit LOD"} {"#name":"keyword" "$":{"id":"k0110"} "$$":[{"#name":"text" "_":"late-onset disease NDI"} {"#name":"keyword" "$":{"id":"k0120"} "$$":[{"#name":"text" "_":"neurodevelopmental impairment NIP"} {"#name":"keyword" "$":{"id":"k0130"} "$$":[{"#name":"text" "_":"National Immunisation Programme NRLBM"} {"#name":"keyword" "$":{"id":"k0140"} "$$":[{"#name":"text" "_":"Netherlands Reference Laboratory for Bacterial Meningitis PAID"} {"#name":"keyword" "$":{"id":"k0150"} "$$":[{"#name":"text" "_":"Practical Application to Include Disease Costs PROM"} {"#name":"keyword" "$":{"id":"k0160"} "$$":[{"#name":"text" "_":"prolonged rupture of membranes QALY"} {"#name":"keyword" "$":{"id":"k0170"} "$$":[{"#name":"text" "_":"quality-adjusted life year QoL"} {"#name":"keyword" "$":{"id":"k0180"} "$$":[{"#name":"text" "_":"quality of life VE"} {"#name":"keyword" "$":{"id":"k0190"} "$$":[{"#name":"text" "_":"vaccine effectiveness WHO"} {"#name":"keyword" "$":{"id":"k0200"} "$$":[{"#name":"text" "_":"World Health Organization |
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