Economics of Vaccination

Einleitung / Introduction

With an estimated 255.000 adult cases annually in Germany (IQTIG, 2020), Community-acquired pneumonia (CAP) poses a significant risk to the population. German data on costs incurred by CAP is scarce and outdated. This lecture will provide a recent estimate of the impact of CAP on different age and risk groups. The medical and social costs derived from this study were used in a cost-effectiveness analyses (CEA) to assess the economic value of potential vaccination strategies. IQTIG. (2020). Qualitätsreport 2020. Retrieved from https://iqtig.org/downloads/berichte/2019/IQTIG_Qualitaetsreport-2020_2021-02-11.pdf

Methode / Method

We conducted a retrospective study using a healthcare claims database with data from >4 million German patients. A study sample from January 1st, 2017 to December 31st, 2019 was analyzed for case fatality (CFR), healthcare resource use (HCRU), medical costs, and social costs attributable to CAP. CAP cases were identified via ICD codes with incident diagnosis of CAP in 2018 and no CAP diagnosis in the 3 months prior to 2018. Attributable values were calculated by subtracting the average values of propensity score (PS) matched controls from the average CAP case values. A systematic literature review (SLR) identified recent data on incidence rates, vaccination history, and herd effects. Results from the claims dataset analysis and data identified from SLR were used to populate a Markov-Type cost-effectiveness model.

Ergebnisse / Results

Of the 31.568 CAP cases, 69% were outpatient and 31% were hospitalized. In the first 30 days of treatment, in-patient CAP attributable medical costs ranged between 5.700€ and 8.300€ depending on age and underlying risk factors and the 365 days costs ranged from 7.200€-19.500€. Outpatient costs ranged from 70€ to 600€ in the first 30 days and 100€-6.000€ for 365 days. Among hospitalized patients 60+ years in age, the attributable CAP CFR 365 days post incident CAP was 26,68%, 21,71%, and 23,05% in high-risk, at-risk, and low-risk patients respectively. For the same population treated in outpatient settings their 365-day attributable CFR was 4,77%, 2,86%, and 3,41%. In the CEA, compared to current German adult pneumococcal vaccine recommendation, the use of PCV15 alone or PCV20 alone was dominant. Additional analyses comparing PCV20 alone versus PCV15 alone showed PCV20 cost 26.2M€ more but saved 4.754 QALYs, resulting in a cost/QALY gained of 5.515€.

Zusammenfassung / Conclusion

The economic burden of CAP is substantial and is primarily driven by hospitalization costs. CAP patient also experienced high long-term mortality, long after the acute CAP episode had ended. The results of the CE analyses suggest that hypothetical PCV15 and PCV20 strategies could be cost-effective alternatives to Germany’s current vaccination program.

AutorInnen

Ernestine Mahar, Pfizer GmbH

Dennis Häckl, WIG2 GmbH

Nils Kossack, WIG2 GmbH

Katharina Actert, inav GmbH

Michelle Kutscher, inav GmbH

Mark Atwood, PAI2 Inc.

Reiko Sato, Pfizer Pharma

Ralf Sprenger, Pfizer GmbH

Christian Theilaker, Pfizer GmbH

Christof von Eiff, Pfizer GmbH

Julia Schiffner-Rohe, Pfizer GmbH

Einleitung / Introduction

The Standing Commission on Vaccination (STIKO) is an independent panel of experts at the Robert Koch Institute (RKI) and is responsible for developing recommendations for the use of licensed vaccines. In the Vaccination Policy (SI-RL) according to § 20i Abs. 1 SGB V the Federal Joint Committee (G-BA) regulates reimbursement of vaccines based on the STIKO recommendations. The aim of this work was to analyze discrepancies regarding target population according to marketing authorization and reimbursement population according to SI-RL as well as the time between marketing authorization and inclusion in the SI-RL.

Methode / Method

All vaccines approved in Germany and listed in the SI-RL were recorded. Duplicates, combined and imported vaccines were removed. All vaccines approved in Germany after April 1, 2006 and recommended by the STIKO after November 1, 2012 were considered (excluding COVID-19 vaccines). The date of G-BA decision on the SI-RL was recorded and discrepancies between target and reimbursement populations and the time between approval and inclusion in the SI-RL were assessed. In addition, the results of STIKO meetings since November 2012 were evaluated using published protocols.

Ergebnisse / Results

Out of a total of 440 vaccines identified, 7 vaccines remained for evaluation after exclusion (Bexsero®, IXIARO®, Rotarix®, RotaTeq®, Shingrix®, Trumenba®, Zostavax®). The time between approval and reimbursement ranged from "without delay" for Trumenba® to 136 months for IXIARO®. 6 of the 7 vaccines are currently reimbursed (IXIARO® under special conditions; Bexsero® 6% of target population; Trumenba® 7%; Shingrix® 59%, Rotarix® and RotaTeq® 100%). A total of 25 STIKO meeting protocols were evaluated. The average time between first discussion and first STIKO assessment was 36 months (6 months for the measles/mumps/rubella/varicella combination vaccine (MMR-V) to 86 months for the varicella vaccine). The human papillomavirus (HPV) vaccine was discussed most frequently (26 times) and the MMR-V combination vaccine was discussed only once. The number of STIKO votings on each vaccine ranged from 0 for the MMR-V combination vaccine to 9 for the shingles vaccine.

Zusammenfassung / Conclusion

In contrast to all other drugs, in Germany the approval of a vaccine does not automatically lead to reimbursement for the target population. In most cases, reimbursement occurs with a significant, not clearly limited delay and only for a subpopulation. STIKO recommendations are published according to STIKO priorities. The content and timing of recommendations are difficult to predict.

AutorInnen

Laura Prünte, co.value

Michael Barth, co.value

Johannes Urban, Pfizer

Einleitung / Introduction

Vaccinating is the most promising exit strategy out of the COVID-19 pandemic. While global vaccination supply accelerated in the first half of 2021, many countries have been struggling with refusal of COVID-19 vaccination in sizeable shares of their populations. Consequently, strategies to increase vaccination readiness are at the forefront of policy discussions in many countries. From an economics perspective, a potentially powerful tool to foster vaccination readiness are social norms, as they are key to facilitate economic transactions by sustaining cooperation among strangers in society and govern a wide range of behavior, from labor supply decisions, charitable giving, political engagement and behavior to school choice. Recent evidence suggests that a non-negligible part of society misperceives existing social norms, and that alleviating these misperceptions can modify economic behavior. If people are misinformed about the social norm to get vaccinated, correcting their misbeliefs through information provision may be a promising approach to foster vaccination readiness in the short run. This is the hypothesis we test in this paper.

Methode / Method

We conducted a two-stage information provision experiment in Germany between March and April 2021, a time when large parts of the population were still unvaccinated. We elicited (descriptive and injunctive) social norms in the first survey (N1 = 2,030) and use the information on descriptive norms in the second survey (N2 = 3,045) as information treatment. Both surveys were conducted with distinct quota-representative samples of the German population. We measure treatment effects on perceived social norms (injunctive and descriptive) and various measures of vaccination readiness, in particular intention to vaccinate (ITV), willingness to pay for vaccination (WTP), and revealed behavior by retrieving information about vaccination registration.

Ergebnisse / Results

We find strong correlations between perceived social norms and all measures of vaccination readiness. Furthermore, we find strong treatment effects on descriptive and injunctive norm beliefs. However, we do not find significant treatment effects on overall vaccination readiness.

Zusammenfassung / Conclusion

The present study investigates the effect of social norms on vaccination readiness. We conducted a two-stage information provision experiment, using quota-representative samples of the German population. We find strong treatment effects on descriptive and injunctive norm beliefs; however, we do not find significant treatment effects on overall vaccination readiness.

AutorInnen

Philipp Lergetporer, TUM School of Management

Daniela Glätzle-Rützler, University of Innsbruck

Silvia Angerer, UMIT Hall