Cost-effectiveness of maternal immunization against neonatal invasive Group B Streptococcus in the Netherlands.

Autor: Hahn BA; Athena Institute, VU Amsterdam, the Netherlands; National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control (Cib), Bilthoven, the Netherlands., de Gier B; National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control (Cib), Bilthoven, the Netherlands. Electronic address: brechje.de.gier@rivm.nl., van Kassel MN; Amsterdam UMC, University of Amsterdam, Department of Neurology, the Netherlands., Bijlsma MW; Amsterdam UMC, University of Amsterdam, Department of Neurology, the Netherlands., van Leeuwen E; Amsterdam UMC, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands., Wouters MGAJ; Amsterdam UMC, University of Amsterdam, Department of Neurology, the Netherlands; Amsterdam UMC, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands., van der Ende A; Amsterdam UMC, Department of Medical Microbiology, Infection and Immunity, and Netherlands Reference Laboratory for Bacterial Meningitis, Amsterdam, the Netherlands., van de Beek D; Amsterdam UMC, University of Amsterdam, Department of Neurology, the Netherlands., Wallinga J; National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control (Cib), Bilthoven, the Netherlands., Hahné SJM; National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control (Cib), Bilthoven, the Netherlands., Jan van Hoek A; National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control (Cib), Bilthoven, the Netherlands.
Jazyk: angličtina
Zdroj: Vaccine [Vaccine] 2021 May 18; Vol. 39 (21), pp. 2876-2885. Date of Electronic Publication: 2021 Apr 22.
DOI: 10.1016/j.vaccine.2021.04.001
Abstrakt: Background: Neonatal 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.
Objective: Explore 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.
Methods: We 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.
Results: Under 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.
Conclusions: A 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.
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
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