Setting Priorities for New Vaccination Programs: An Analysis of Pneumococcal and Herpes Zoster Vaccines

OBJECTIVES: Vaccination is one of the most cost-effective public-health measures and a key tool for primary prevention. Public-health decision-makers seeking to maximize population health subject to given budget constrain. To boost demand for merit goods, financial incentives such as free vaccination programs or co-payments can improve coverage and health equity. This cost comparison analysis evaluates which of two vaccination-programs should be prioritized in Austria: herpes-zoster or pneumococcal-infection. Both currently require out-of-pocket payment. Economic efficiency is assessed by maximizing outcomes under the secondary condition of the rational use of scarce resources. The goal is to quantify medical costs and cases avoided to compare them with vaccination costs.

METHODS: The analysis compares direct and indirect costs and cases of both infections with and without vaccination. In the vaccination group, 22% of adults are vaccinated. Two structured multi-cohort, population-based models were developed, including the following health-states: healthy, illness due to infection, complications, and death. Complications include post-herpetic neuropathy for zoster, epilepsy and deafness for pneumococcal infection. Costs (in 2023 Euros) are determined from a bottom-up approach for one year based on the health-care-systems and societal perspective. Vaccination costs are based on the pharmacy selling price.

RESULTS: Results show that spending 1€ on pneumococcal vaccination saves 1.86€ in healthcare costs, compared to 0.13€ for herpes-zoster vaccination. From a societal perspective, the savings are 2.24€ and 0.24€, respectively. To save 1 million euro in healthcare costs, private spending of 7.1 million euro is needed in case of herpes-zoster vaccination, but only 43,000€ in case of pneumococcal vaccination. In terms of costs per avoided case, it takes 3,610€ to prevent one case of herpes-zoster or post-herpetic-neuralgia, compared to 869€ to prevent one case of pneumococcal disease.

CONCLUSIONS: Overall, the analysis concludes that the return on investment in pneumococcal vaccination is several times higher than an investment in herpes-zoster vaccination.