Cost-effectiveness of maternal immunization against neonatal invasive Group B Streptococcus in the Netherlands.

Abstract

BACKGROUND:

Neonatal invasive Group B Streptococcus (GBS) infection causes considerable disease burden in the Netherlands. Intrapartum antibiotic prophylaxis (IAP) prevents early-onset disease (EOD), but has no effect on late-onset disease (LOD). A potential maternal GBS vaccine could prevent both EOD and LOD by conferring immunity in neonates.

OBJECTIVE:

Explore under which circumstances maternal vaccination against GBS would be cost-effective as an addition to, or replacement for the current risk factor-based IAP prevention strategy in the Netherlands.

METHODS:

We assessed the maximum cost-effective price per dose of a trivalent (serotypes Ia, Ib, and III) and hexavalent (additional serotypes II, IV, and V) GBS vaccine in addition to, or as a replacement for IAP. To project the prevented costs and disease burden, a decision tree model was developed to reflect neonatal GBS disease and long-term health outcomes among a cohort based on 169,836 live births in the Netherlands in 2017.

RESULTS:

Under base-case conditions, maternal immunization with a trivalent vaccine would gain 186 QALYs and prevent more than €3.1 million in health care costs when implemented in addition to IAP. Immunization implemented as a replacement for IAP would gain 88 QALYs compared to the current prevention strategy, prevent €1.5 million in health care costs, and avoid potentially ~ 30,000 IAP administrations. The base-case results correspond to a maximum price of €58 per dose (vaccine + administration costs; using a threshold of €20,000/QALY). Expanding the serotype coverage to a hexavalent vaccine would only have a limited additional impact on the cost-effectiveness in the Netherlands.

CONCLUSIONS:

A maternal GBS vaccine could be cost-effective when implemented in addition to the current risk factor-based IAP prevention strategy in the Netherlands. Discontinuation of IAP would save costs and prevent antibiotic use, however, is projected to lead to a lower health gain compared to vaccination in addition to IAP.

• Authors: Brett A Hahn, Brechje de Gier, Merel N van Kassel, Merijn W Bijlsma, Elisabeth van Leeuwen, Maurice G A J Wouters, Arie van der Ende, Diederik van de Beek, Jacco Wallinga, Susan J M Hahné, Albert Jan van Hoek
• Journal: Vaccine (Vaccine) Vol. 39 Issue 21 Pg. 2876-2885 (05 18 2021) ISSN: 1873-2518 [Electronic] Netherlands
• PMID: 33895018 (Publication Type: Journal Article)
• Copyright: Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.

Topics

• Antibiotic Prophylaxis
• Cost-Benefit Analysis
• Female
• Humans
• Immunization
• Infant, Newborn
• Infectious Disease Transmission, Vertical
• Netherlands
• Pregnancy
• Pregnancy Complications, Infectious (drug therapy)
• Streptococcal Infections (drug therapy, prevention & control)
• Streptococcus agalactiae
• Vaccination