Sun-Young Kim1, Chi Nguyen2, Louise B Russell3, Sara Tomczyk4, Fatimah Abdul-Hakeem5, Stephanie J Schrag6, Jennifer R Verani7, Anushua Sinha8. 1. Department of Healthcare Management and Policy, School of Public Health, Seoul National University, Seoul, South Korea. Electronic address: sykim22@snu.ac.kr. 2. Department of Epidemiology, Human Genetics, & Environmental Sciences, University of Texas School of Public Health, Houston, TX, USA. Electronic address: chi.h.nguyen@uth.tmc.edu. 3. Department of Economics and Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA. Electronic address: louisebrussell1983@gmail.com. 4. National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: xdj2@cdc.gov. 5. Department of Health Systems and Policy, Rutgers School of Public Health, Rutgers University, Piscataway, NJ, USA. Electronic address: fatimahabdulh@gmail.com. 6. National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: zha5@cdc.gov. 7. National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: qzr7@cdc.gov. 8. Department of Health Systems and Policy, Rutgers School of Public Health, Rutgers University, Piscataway, NJ, USA. Electronic address: anushua.sinha@gmail.com.
Abstract
BACKGROUND: In the U.S., intrapartum antibiotic prophylaxis (IAP) for pregnant women colonized with group B streptococcus (GBS) has reduced GBS disease in the first week of life (early-onset/EOGBS). Nonetheless, GBS remains a leading cause of neonatal sepsis, including 1000 late-onset (LOGBS) cases annually. A maternal vaccine under development could prevent EOGBS and LOGBS. METHODS: Using a decision-analytic model, we compared the public health impact, costs, and cost-effectiveness of five strategies to prevent GBS disease in infants: (1) no prevention; (2) currently recommended screening/IAP; (3) maternal GBS immunization; (4) maternal immunization with IAP when indicated for unimmunized women; (5) maternal immunization plus screening/IAP for all women. We modeled a pentavalent vaccine covering serotypes 1a, 1b, II, III, and V, which cause almost all GBS disease. RESULTS: In the base case, screening/IAP alone prevents 46% of EOGBS compared to no prevention, at a cost of $70,275 per quality-adjusted life-year (QALY) from a healthcare and $51,249/QALY from a societal perspective (2013 US$). At coverage rates typical of maternal vaccines in the U.S., a pentavalent vaccine alone would not prevent as much disease as screening/IAP until its efficacy approached 90%, but would cost less per QALY. At vaccine efficacy of ≥70%, maternal immunization together with IAP for unimmunized women would prevent more disease than screening/IAP, at a similar cost/QALY. CONCLUSIONS: GBS maternal immunization, with IAP as indicated for unvaccinated women, could be an attractive alternative to screening/IAP if a pentavalent vaccine is sufficiently effective. Coverage, typically low for maternal vaccines, is key to the vaccine's public health impact.
BACKGROUND: In the U.S., intrapartum antibiotic prophylaxis (IAP) for pregnant women colonized with group B streptococcus (GBS) has reduced GBS disease in the first week of life (early-onset/EOGBS). Nonetheless, GBS remains a leading cause of neonatal sepsis, including 1000 late-onset (LOGBS) cases annually. A maternal vaccine under development could prevent EOGBS and LOGBS. METHODS: Using a decision-analytic model, we compared the public health impact, costs, and cost-effectiveness of five strategies to prevent GBS disease in infants: (1) no prevention; (2) currently recommended screening/IAP; (3) maternal GBS immunization; (4) maternal immunization with IAP when indicated for unimmunized women; (5) maternal immunization plus screening/IAP for all women. We modeled a pentavalent vaccine covering serotypes 1a, 1b, II, III, and V, which cause almost all GBS disease. RESULTS: In the base case, screening/IAP alone prevents 46% of EOGBS compared to no prevention, at a cost of $70,275 per quality-adjusted life-year (QALY) from a healthcare and $51,249/QALY from a societal perspective (2013 US$). At coverage rates typical of maternal vaccines in the U.S., a pentavalent vaccine alone would not prevent as much disease as screening/IAP until its efficacy approached 90%, but would cost less per QALY. At vaccine efficacy of ≥70%, maternal immunization together with IAP for unimmunized women would prevent more disease than screening/IAP, at a similar cost/QALY. CONCLUSIONS:GBS maternal immunization, with IAP as indicated for unvaccinated women, could be an attractive alternative to screening/IAP if a pentavalent vaccine is sufficiently effective. Coverage, typically low for maternal vaccines, is key to the vaccine's public health impact.
Authors: Srinivas Acharya Nanduri; Susan Petit; Chad Smelser; Mirasol Apostol; Nisha B Alden; Lee H Harrison; Ruth Lynfield; Paula S Vagnone; Kari Burzlaff; Nancy L Spina; Elizabeth M Dufort; William Schaffner; Ann R Thomas; Monica M Farley; Jennifer H Jain; Tracy Pondo; Lesley McGee; Bernard W Beall; Stephanie J Schrag Journal: JAMA Pediatr Date: 2019-03-01 Impact factor: 16.193
Authors: David D Kim; Madison C Silver; Natalia Kunst; Joshua T Cohen; Daniel A Ollendorf; Peter J Neumann Journal: Pharmacoeconomics Date: 2020-10 Impact factor: 4.981
Authors: Simon R Procter; Omar Salman; Clint Pecenka; Bronner P Gonçalves; Proma Paul; Raymond Hutubessy; Philipp Lambach; Joy E Lawn; Mark Jit Journal: Vaccine Date: 2020-08-01 Impact factor: 3.641