Costs and effectiveness of extended vaccination strategies against pertussis and pneumococcal disease

Mark Hermannes Rozenbaum

    Research output: ThesisThesis fully internal (DIV)

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    A crowded vaccination schedule and restrained health–care budgets limit the uptake of new vaccines into the Dutch national immunization programs (NIP). Next to many other factors, costeffectiveness considerations highly influence the decision whether to introduce vaccines into Dutch NIP.
    The first part of this thesis focuses on the (cost-) effectiveness of pneumococcal vaccination. It is shown that there are large differences in the observed disease epidemiology after implementation of paediatric pneumococcal immunization programs between the USA and Europe. In Europe, less cases of pneumococcal disease were avoided in unvaccinated individuals (herd effects) than in the
    USA, while significant replacement was observed in Europe with strains not included in the vaccine.
    As a consequence, the 7-valent pneumococcal vaccine, which was previously used in the Dutch NIP, was less cost-effective as predicted beforehand. More valent pneumococcal vaccines are more likely to be considered cost-effective as more direct and herd effects and less serotype replacement effects are expected. These potential herd effects reduce the cost-effectiveness of elderly and adult (risk) groups vaccination in time. In particular, a modelling study showed that vaccinating risk groups in England was unlikely to be considered cost-effective in the base-case analysis unless the vaccine would also offer protection against non–bacteraemic pneumonia. Evidence on whether the latter occurs is awaited from a large Dutch clinical trial.
    The second part of the thesis explores the impact of extending the childhood pertussis vaccination programme to adolescents and adults. Given the nature of the problem, the development of a complex population dynamical model was required. The developed dynamic model showed that the most (cost-) effective age for the introduction of an additional booster is around 12 years. Nevertheless, this strategy only offered limited indirect protection to the (partly)
    unvaccinated infants with potentially most serious disease which might be considered the primary aim of extended pertussis vaccination.
    In conclusion, the dynamics of infectious diseases makes it challenging to predict the impact of new vaccination programs. Extending the vaccination programs against pneumococcal disease and pertussis offers the possibility to prevent morbidity and mortality and decrease the economic burden of disease for society.
    Original languageEnglish
    • Postma, Maarten, Supervisor
    • Hak, Eelko, Supervisor
    Award date25-Feb-2013
    Print ISBNs9789036759908
    Electronic ISBNs9789036759915
    Publication statusPublished - 2013

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