Background. Pneumococcal conjugate vaccine for infants has
recently been found to be effective for prevention of meningitis, bacteremia,
pneumonia and otitis media, but it is more costly than previously introduced
vaccines.
Aim. We sought to determine the savings in medical costs through 36
months of life attributable to the use of the vaccine in healthy infants in a
large randomized trial.
Methods. We analyzed the actual medical costs of 36 471 children
involved in a randomized trial of heptavalent pneumococcal conjugate vaccine
conducted in the Northern California Kaiser Permanente Medical Care Program.
The costs of the vaccine and vaccine administration were excluded.
Results. Compared with the control group, the vaccinated group
experienced a 2% reduction in clinic related costs [$48; 95% confidence
interval (CI), $10 to $83] and a nearly significant 14% reduction in
outpatient hospitalization costs ($32; CI –$1 to $66). The savings in total
medical costs were 1.2%, but this difference was not significant ($41; CI
–$204 to $270). Inpatient hospital costs were highly variable and were
responsible for the lack of precision in the difference in total cost. In a
post hoc analysis that excluded hospital costs not believed to be
potentially pneumococcal related, savings in medical costs were $78 and
significant (CI $5 to $158).
Conclusions. The pneumococcal conjugate vaccine reduced ambulatory
care costs in children in the first 36 months of life, but without a larger
trial, the magnitude of the savings in total medical costs is uncertain. These
results indicate, however, that any medical cost savings that are associated
with the vaccine are unlikely to be high enough to offset the cost of the
vaccine at its current price.
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