Evaluation of universal Hepatitis B vaccination program in Finland Should we start one?

Transcription

1 Evaluation of universal Hepatitis B vaccination program in Finland Should we start one? NVM Heini Salo, Tanja Karvonen, Markku Nurhonen, Kari Auranen, Tuija Leino 1

2 To evaluate the need and the costeffectiveness of universal immunisation programme We need to know: Number of annual cases due to Hep B: Acute hepatitis B Chronic hepatitis B Cirrhosis Cancer Deaths Mean healthcare service use /case Quality of life lost? Mean cost /case (healthcare payers prospective) 2

3 Data collected Hospital Pharmacies Infectious Disease Register Transplant Register Hospital Care Register Primary Health Care Register FMC Medical Birth Register Death Register Cancer Register Number of cases Healthcare servises used per case Mean costs per case National registers with unique identifiers! 3

4 Transmission presently? 4

5 Infectious Disease Register: acute Hep B cases Electronic notifications directly from lab! Acute case : IgM+ 5

6 Infectious Disease Register: 3 recent years ~20 acute cases /y

7 What happends to the infected? Disease burden in Finland presently? 7

8 ICD-10 and ICPC-2 codes used in secondary and primary health care registers: ICD-10 Acute hep B infection: B16 Chronic hep B infection: B17.0, B18.0, B18.1, P35.31, Z22 Cirrhosis: K70, K73, K74 Cancer: C22 ICPC-2 Viral hepatitis: D72 8

9 Hospital care register: Healthcare services used per case: acute hepatitis B Acute hepatitis B (ICD10: B16) Acute hepatitis B (ICD10: B16) as primary diagnosis Acute disease symptoms Liver failure Liver disease symptoms days 1-90 days Inflammatory liver diseases, when acute hepatitis B other diagnosis days IgM antibodies in Infectious Disease Register

10 Mean healthcare costs per case 1/2 Mean use of healthcare services X unit costs by service type (Kapiainen 2014) /case* Acute hepatitis B Chronic hepatitis B 1.year years years 36 Cirrhosis 1.year years Cancer 1.year year years *over age groups (in the analysis costs varied by age group) 10

11 Mean healthcare costs per case 2/2 Viral medication /year < 50 years of age years of age Transplantation (Åberg 2011)* Fulminant infection /case 1. year years Cirrhosis and cancer cases 1. year years *Including transplantation, treatment and immunosuppressive medication 11

12 Quality-adjusted life-years (QALYs) lost /case presented by age-groups Age Reference Acute 0,007 0,007 0,007 0,007 0,007 0,006 0,006 assumption Chronic, specialised care 0,05 0,05 0,05 0,05 0,05 0,05 0,05 Scalone 2015 Cirrhosis, compensated 0,117 0,115 0,114 0,113 0,111 0,109 0,101 Åberg 2011 Cirrhosis, decompensated 0,306 0,3 0,298 0,295 0,29 0,284 0,263 Åberg 2011 Fulminant, 1st year 0,62 0,614 0,613 0,61 0,606 0,6 0,58 Åberg 2011 Fulminant, years 2+ 0,117 0,115 0,114 0,113 0,111 0,109 0,101 Åberg 2011 Transplantation, years after 0,046 0,045 0,044 0,044 0,043 0,042 0,039 Åberg 2011 Cancer, years ,268 0,262 0,261 0,25 0,24 0,234 0,201 Longworth 2003 Cancer, years 3+ 0,069 0,067 0,067 0,066 0,065 0,064 0,059 Saarni

13 Mean number of annual cases during and the proportion of Finnish-born hepatitis cases Cases/year Finnish-born Cases /year Age Acute Chronic Acute Chronic Cirrhosis Cancer Total

14 Annual healthcare costs ( ) under present i.e. targeted immunisation programme Age Acute Chronic Cirrhosis Cancer Total Total

15 Cots-effectiveness of the universal immunisation programme? 15

16 How many new hepatitis B cases annually? Probability of symptoms depend on age +60% We added asymptomatic cases to get the true number of acute cases! +85% Hahne et al., 2004, Edmunds et al

17 Estimated true incidence of acute hepatitis B during by age Number of acute cases 17

18 How many of these will get chronic infection? Probability of chronic hep B infection depends also on age (a): At the age < 1 year probability is At the age >32 years probability is 0.04 Edmunds et al., 1993, Hyams, rev

19 Found in registers! Population:

20 Hepatitis B cases without universal immunisation programme ( /58 000) Number of acute cases corresponds to symptomatic infections 20

21 Estimated annual number of cases by age group and number of cases prevented by the immunisation programme Immunisation: 95% effectiveness, 95% coverage Cases, without universal immunisation programme Cases prevented by the programme Total Acute, no symptoms 6,3 20,0 6,2 0 32,4 29,0 Acute, symptomatic 0,3 4,4 3,6 0 8,2 7,4 Chronic 1,6 1,4 0,4 0 3,5 3,1 Cirrhosis 0 0,8 0,8 0,3 1,9 1,7 Cancer 0 0,4 0,5 0,2 1,2 1,1 Death due to hep B 0 0,8 1,2 0,6 2,5 2,3 21

22 LYs and QALYs lost due to hepatitis B and LYs and QALYs gained by the universal immunisation programme (/58 000) LYs lost LYs saved QALYs lost total* QALYs gained total* Discount 0% 3% 0% 3% 0% 3% 0% 3% Fulminant infection 3,4 0,6 3,1 0,5 3,7 0,7 3,3 0,6 Cirrhosis 39,6 6,9 35,7 6,2 39,9 7,0 36,0 6,3 Cancer 40,8 6,7 36,8 6,0 43,1 7,3 38,9 6,6 Total 83,7 14,2 75,6 12,8 84,1 14,3 75,9 12,9 *includes both fatal and non-fatal QALYs lost 22

23 The estimated undiscounted and discounted (3%) medical costs and costs saved by the universal programme ( /58 000) Discount rate 3% Medical costs ( ), without universal immunisation programme Total Cost saved by the universal programme ( ) Acute Chronic Cirrhosis Cancer Total Discount rate 0% Acute Chronic Cirrhosis Cancer Total

24 Cost-effectiveness of the immunisation programme - at which vaccine price difference? 24

25 Base case: When using 6val instead of 5val vaccine: cost difference per dose programme cost (60 000x 3) Saved treatment costs Healthcare costs total QALYs gained (tot) 13,6 13,6 13,6 13,6 Life years gained 12,8 12,8 12,8 12,8 Cost per QALY gained / Cost per LY gained /

26 Estimated true incidence of acute hep B during by age 2x 26

27 cost difference per dose programme costs (60 000x 3) Base case Saved treatment costs Healthcare costs total QALYs gained (tot) 13,6 13,6 13,6 13,6 13,6 LY gained 12,8 12,8 12,8 12,8 12,8 Cost per QALY gained / Cost per LY gained / x the incidence <18y Cost per LY gained / X the incidence Cost per LY gained /

28 Additional cost in per QALY gained as the price of the 6-val vaccine increases Base case 2x under 18y incidence 2x total incidence 28

29 29

30 Thank you! Questions to us? Heini Salo, Tanja Karvonen, Markku Nurhonen, Kari Auranen, Tuija Leino 30

31 vaccine dose vaccine costs (60 000x 3) Base case Saved treatment costs Health care costs total Saved QALYs* 13,6 13,6 13,6 13,6 13,6 Saved life years 12,8 12,8 12,8 12,8 12,8 /additional-qaly /additional life year x the incidence <18y Saved treatment costs Health care costs total Saved QALYs* 20,0 20,0 20,0 20,0 20,0 Saved life years 18,9 18,9 18,9 18,9 18,9 /additional-qaly /additional life year X the incidence Saved treatment costs Health care costs total Saved QALYs* 27,2 27,2 27,2 27,2 27,2 Saved life years 25,6 25,6 25,6 25,6 25,6 /additional-qaly /additional life year *both life years and QALYs 31