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Dynamic transmission model of routine mumps vaccination in Japan.

ABSTRACT: The mumps vaccine is not included in the national immunisation programme (NIP) of approximately 80 countries including Japan. To investigate the vaccine's cost-effectiveness, we developed a dynamic transmission model for routine one- and two-dose mumps vaccination programs in Japan. We calculated the incremental cost-effectiveness ratio compared with a current programme over a projected 50-year period. We created a Japanese population model and performed dynamic simulation to estimate the number of patients enrolled in the current programme, the routine one-dose programme, and the routine two-dose programme over the next 50 years using the Berkeley Madonna program. We estimated the medical and social costs of natural mumps infections and vaccinations to analyse cost-effectiveness. Finally, we performed a sensitivity analysis with parameters including vaccine cost, vaccine efficacy, medical costs per case, social costs per case, incidence of adverse events and discount rate. Base case analysis showed that both the one-dose and two-dose programmes predominated and that quality-adjusted life years (QALYs) were saved, compared with the current programme. The medical costs, total cost and QALYs saved during the study period in the two-dose programme compared with the current programme were 217 billion JPY, 860 billion JPY and 184 779, respectively. The two-dose programme surpassed the one-dose programme throughout the study period. In all the scenarios of the sensitivity analysis, two-dose vaccination was better than the one-dose programme. This simulation confirmed that the routine two-dose vaccination programme was more cost-effective and QALY-saving than either the one-dose programme or the current programme. Because of the variability of the results between the various models, further simulations with different models should be conducted.

SUBMITTER: Kitano T

PROVIDER: S-EPMC6518553 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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Project description:UnlabelledIntroductionPersistent infections with human papillomavirus (HPV) are a necessary cause of cervical cancer and are responsible for important morbidity in men and women. Since 2007, HPV vaccination has been recommended and funded for all girls aged 12 to 17 in Germany. A previously published cost-effectiveness analysis, using a static model, showed that a quadrivalent HPV vaccination programme for 12-year-old girls in Germany would be cost effective. Here we present the results from a dynamic transmission model that can be used to evaluate the impact and cost-effectiveness of different vaccination schemas.MethodsWe adapted a HPV dynamic transmission model, which has been used in other countries, to the German context. The model was used to compare a cervical cancer screening only strategy with a strategy of combining vaccination of females aged 12-17 years old and cervical cancer screening, based on the current recommendations in Germany. In addition, the impact of increasing vaccination coverage in this cohort of females aged 12-17 years old was evaluated in sensitivity analysis.ResultsThe results from this analysis show that the current quadrivalent HPV vaccination programme of females ages 12 to 17 in Germany is cost-effective with an ICER of 5,525€/QALY (quality adjusted life year). The incremental cost-effectiveness ratio (ICER) increased to 10,293€/QALY when the vaccine effects on HPV6/11 diseases were excluded. At steady state, the model predicted that vaccinating girls aged 12 to 17 could reduce the number of HPV 6/11/16/18-related cervical cancers by 65% and genital warts among women and men by 70% and 48%, respectively. The impact on HPV-related disease incidence and costs avoided would occur relatively soon after initiating the vaccine programme, with much of the early impact being due to the prevention of HPV6/11-related genital warts.ConclusionsThese results show that the current quadrivalent HPV vaccination and cervical cancer screening programmes in Germany will substantially reduce the incidence of cervical cancer, cervical intraepithelial neoplasia (CIN) and genital warts. The evaluated vaccination strategies were all found to be cost-effective. Future analyses should include more HPV-related diseases.

Project description:BACKGROUND:Mumps is a vaccine-preventable disease but outbreaks have been reported in persons vaccinated with two doses of MMR vaccine. The objective was to describe the demographic features, vaccination effectiveness and genetic mumps virus diversity among laboratory-confirmed cases between 2007 and 2011 in Catalonia. METHODS:Cases and outbreaks of mumps notified to the notifiable diseases system of Catalonia between 2007 and 2011 retrospectively registered were included. Public health care centres provided written immunization records to regional public health staff to determine the vaccination history. Saliva and serum specimens were collected from suspected cases for laboratory-confirmation using real-time reverse-transcriptase PCR (rtRT-PCR) or serological testing. Phylogenetic analysis of the complete SH gene (316 nucleotides) and complete coding HN protein (1749 nucleotides) sequences was made. Categorical variables were compared using the Chi-square or Fisher's tests and continuous variables using the Student test. Vaccination effectiveness by number of MMR doses was estimated using the screening method. RESULTS:During the study period, 581 confirmed cases of mumps were notified (incidence rate 1.6 cases/100,000 persons-year), of which 60% were male. Three hundred sixty-four laboratory-confirmed cases were reported, of which 44% were confirmed by rtRT-PCR. Of the 289 laboratory-confirmed cases belonging to vaccination cohorts, 33.5% (97) had received one dose of MMR vaccine and 50% (145) two doses. Based on phylogenetic analyses of 316-nucleotide and 174-nucleotide SH sequences, the viruses belonging to viral genotypes were: genotype G (126), genotype D (23), genotype H (2), genotype F (2), genotype J (1), while one remained uncharacterized. Amino acid differences were detected between circulating strains and the Jeryl Lynn vaccine strains, although the majority of amino acid substitutions were genotype-specific. Fifty-one outbreaks were notified that included 324 confirmed mumps cases. Genotype G was the most frequent genotype detected. The family (35%), secondary schools (25%) and community outbreaks (18%) were the most frequent settings. CONCLUSIONS:Our study shows that genotype G viruses are the most prevalent in Catalonia. Most cases occurred in people who had received two doses of MMR, suggesting inadequate effectiveness of the Jeryl Lynn vaccine strain. The possible factors related are discussed.

Project description:ObjectivesComprehensive cost-effectiveness analyses of introducing varicella and/or herpes zoster vaccination in the Swedish national vaccination programme.DesignCost-effectiveness analyses based on epidemiological results from a specifically developed transmission model.SettingNational vaccination programme in Sweden, over an 85- or 20-year time horizon depending on the vaccination strategy.ParticipantsHypothetical cohorts of people aged 12 months and 65-years at baseline.InterventionsFour alternative vaccination strategies; 1, not to vaccinate; 2, varicella vaccination with one dose of the live attenuated vaccine at age 12 months and a second dose at age 18 months; 3, herpes zoster vaccination with one dose of the live attenuated vaccine at 65 years of age; and 4, both vaccine against varicella and herpes zoster with the before-mentioned strategies.Main outcome measuresAccumulated cost and quality-adjusted life years (QALY) for each strategy, and incremental cost-effectiveness ratios (ICER).ResultsIt would be cost-effective to vaccinate against varicella (dominant), but not to vaccinate against herpes zoster (ICER of EUR 200,000), assuming a cost-effectiveness threshold of EUR 50,000 per QALY. The incremental analysis between varicella vaccination only and the combined programme results in a cost per gained QALY of almost EUR 1.6 million.ConclusionsThe results from this study are central components for policy-relevant decision-making, and suggest that it was cost-effective to introduce varicella vaccination in Sweden, whereas herpes zoster vaccination with the live attenuated vaccine for the elderly was not cost-effective-the health effects of the latter vaccination cannot be considered reasonable in relation to its costs. Future observational and surveillance studies are needed to make reasonable predictions on how boosting affects the herpes zoster incidence in the population, and thus the cost-effectiveness of a vaccination programme against varicella. Also, the link between herpes zoster and sequelae need to be studied in more detail to include it suitably in health economic evaluations.

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Dynamic transmission model of routine mumps vaccination in Japan.

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