Josephine van Dongen

Chapter 3 82 Scenario ∆ QALY ∆ soc- ietal cost (in mio. €) a ICER (€/ QALY) - Societal perspec- tive ∆ health- care cost (in mio. €) a ICER (€/ QALY) - Health- care payer perspec- tive Induced IS/com- plicated IS cases Induced IS: prevent- ed fatal cases Induced IS: pre- vented hospital- ized cases Mean (95% CI) Mean (95% CI) Mean (95% CI) Mean (95% CI) Mean (95% CI) Mean (95% CI) Mean (95% CI) Mean (95% CI) w.r.t. older age at first infection and consequently slightly lower probability of seeking medical care e 50% of 0-1 year olds were assumed to be 1-2 years old when infected 1052 (383- 1873) -14.3 (-17.8 - - 11.3) cost-sav- ing (cs-cs) -9.0(- 11.9- - 6.5) cost-sav- ing (cs-cs) 4.61/0.22 1:20 (1:11- 1:31) :1532 (1:1340- 1:1725) 75% of 0-1 year olds were assumed to be 1-2 years old when infected 9968 (335- 1773) -12.7 (-15.9- - 9.8) cost-sav- ing (cs-cs) -7.7 (-10.4-- 5.4) cost-sav- ing (cs-cs) 4.61/0.22 1:19 (1:10- 1:29) 1:1420 (1:1239- 1:1602) w.r.t. assumed vaccine coverage (in baseline: 86% coverage) Vaccine coverage: 75% 1113 (406- 1987) -14.8 (-18.1-- 11.8) cost-sav- ing (cs-cs) -9.6 (-12.4-- 7.3) cost-sav- ing (cs-cs) 4.02/0.19 1:24 (1:13- 1:37) 1:1707 (1:1494- 1:1920) CI: confidence interval; cs: cost-saving; (cs-cs): 95%CI limits both cost-saving; IS: intussusception; S.A.: Sensitivity analysis or scenario analysis. a)Note: negative costs are savings b)In the earlier model the assumed hours of work loss for mild cases were: 0.93; 1.36; 0.84 days for ages 0 to 4; 5 to 9 and 10 to 14 years respectively, versus in the baseline: 1 day (~8 hours) in 5% of episodes for children under the age of 10 and for children > 10 years of age work loss estimates were reduced by 50%. In the earlier model the assumed hours of work loss for moderate cases were: 1.35; 1.98; 1.23 for ages 0 to 4; 5 to 9 and 10 to 14 years respectively, versus in the baseline: 0.5 - 2 days in 25% of episodes for children under the age of 10 and for children > 10 years of age work loss estimates were reduced by 50%. c)Bruijning et al. 8 used 0.0011, 0.0022, 0.0022 and 0.0020 for mild, moderate, severe and nosocomial infections, respectively. d)We included slightly higher QALY losses based on the sensitivity analysis of Marlow et al. (for hospitalizations 0.0039 vs 0.0030 in the baseline and for GP visits 0.0030 vs 0.0022 in the baseline) 9 ) e)On average 21.5% of the 0-1 years old would require a GP visit, whereas only 18.5% of 1-4 years old ( Table 1 ). As the GP has a gatekeeper function in the Netherlands, we modelled that on average 27.6% of the 0-1 year olds visiting a GP would require hospitalization, whereas this would be only 16.4% if 1-4 years old.These averages were derived from the baseline simulations results.