To assess the economic effects of RV vaccination, cost-effectiveness analyses based on Markov cohort models are typically used (see e.g., Standaert et al. [ 18] for RV hospitalizations in Belgium [ 18]).
The model is extensively validated and has the ability to calculate potential impact of breastfeeding on vaccination cost-effectiveness.
Considering the age at vaccination, cost-effectiveness is decreasing (indicated by higher ICERs) between the age of 55 and 75 years.
Vaccination cost-effectiveness, however, would be US$37,480/QALY at a discounted rate of 5% since higher discount rates augment the relative weight of the initial vaccination costs.
A recent review of HPV vaccination cost-effectiveness modeling concluded that increasing female coverage appears to be a better investment, but that vaccination of boys may be cost-effective when female coverage is less than 50% and it costs about US$400-500400-500ccinated girl/boy [ 1].
Sensitivity analyses were conducted for key model parameters to determine how alternative assumptions about pre-emptive vaccination affected the relative cost effectiveness pre-emptive and reactive vaccination strategies.
Broadened prevention of AOM would have an important effect on cost effectiveness of vaccination [ 75- 77].
For severe pandemics, the addition of sustained SD and AV to reactive vaccination improves the relative cost effectiveness by decreasing total pandemic costs and increasing the number of life year saved.
For instance, if there are no herd effects resulting from the additional types now included in the infant vaccination programme then the cost effectiveness of targeting all high risk groups would be reduced from over £180 000 to around £47 000 per QALY gained.
Another key finding is that non-vaccination interventions, including antiviral treatment and prophylaxis, and social distancing measures such as school closure, are complementary to vaccination, improving the effectiveness and cost effectiveness of both pre-emptive and reactive vaccination.
