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Global Insight Perspective
Pneumococcal infections are very frequent in Spain, requiring around 500 hospitalisations a year per 100,000 inhabitants, with 1.6% of healthcare costs being spent on pneumococcal infections.
Pneumococcal vaccination can help prevent disease. Cost effectiveness on the basis of morbidity and mortality data suggests an important reduction in the resistance to pneumococcal infections as a result of the introduction of the heptavalent vaccine.
Evidence to date on the benefits from the vaccination programme in children shows significant cost savings can be made. However, universal access and state-cover vary greatly from province to province, and in some cases treatment is only within reach of people with a certain amount of spending power.
The latest epidemiological studies on the incidence of pneumococcal meningitis in Spain indicate that in more than half of the cases, the affected person is younger than one year of age. This infection is also responsible for 20% of cases of acquired pneumonia and a number of cases of paediatric otitis. Pilar Farjas, specialist in preventative medicine and head of the service of sanitary products, says that the real incidence of pneumococcal infections is between 200 and 500 cases per 100,000 people a year, requiring around 500 hospitalisations per 100,000 inhabitants a year. In addition, the economic and social costs of antibiotic treatment for pneumococcal infections that need hospitalisation are high, according to experts.1.6% of hospital costs are caused by pneumococcal infections, or around 70,000 patients, of whom the majority are above 64 years of age. Pneumococcal disease is an infection caused by the bacterium Streptococcus pneumoniae, which can cause serious, possibly life-threatening illnesses, such as pneumonia, septicaemia (blood poisoning) and meningitis.
Economic Benefits from Universal Vaccination Programme in Children
A case for universal vaccination in Spain is being argued, especially considering the reduced resistance to antibiotics and the incidence of pneumococcal infections all over Europe. Pneumococcal infections in Spain are being targeted on three fronts: primary care, at the hospital and from the public health perspective. According to Javier Diez from the Vaccine Advisory Committee of AEP, pneumococcal diseases are continuing to be a very frequent pathology in Spain, and are capable of producing “invading pathology” (the most serious, but less common manifestation) or non-invading infections (more frequent).
In the case of pneumococcal vaccination in children, significant healthcare savings are evident (see table).
Cost of Disease without Vaccination (euro)
Cost of disease with Vaccination (euro)
Economic benefits from the Programme (euro)
Source:ReES, El Global
Wyeth’s heptavalent pneumococcal vaccine Prevnar is one of the company's best selling pharmaceutical products, with full-year 2006 worldwide sales of US$1,961 million. Prevnar is a seven-valent vaccine, containing the cell membrane sugars of seven serotypes of pneumococcus, conjugated with Diphteria proteins.
Outlook and Implications
The main question is whether universal introduction of the pneumococcal vaccine would be cost effective in Spain. According to the Spanish Ministry of Health, introduction of the vaccine is reducing resistance to pneumococcal infections, and this could lead to a return to treating infections with classic antibiotics and reduction of pharmaceutical costs. At present two types of pneumococcal vaccines are in use in Spain: the non-conjugated 23-valent vaccine for the elderly and the heptavalent conjugated pneumococcal vaccine in children.So far, economic analysis of the cost effectiveness of the pneumococcal vaccine has proved difficult because the pneumococcal bacteria is a pathogen that we still know little about. One way forward is to look at the valuation of cost of treatment on the basis of morbidity and mortality. According to this criteria, the Spanish Ministry of Health is registering an important reduction in the resistance to pneumococcal infections, and attributes this to the gradual and arbitrary introduction of the heptavalent vaccine. Given that pneumococcal infections require hospitalisation predominantly in the elderly population (above 63 years of age), the increasing effect of the aging population will only further increase costs. Spain has so far incorporated the vaccination of people older than 64 years of age in the provinces of Catalonia and Galicia, along with the annual anti-influenza vaccine. Unlike the influenza vaccine which needs to be given annually, the pneumococcal vaccine doesn't need to be re-administered every year, which is an additional benefit. In the case of children however, the situation is somewhat different; vaccination is reimbursed in Madrid, but in the rest of the country it is financed by public health for certain risk groups, and people need to pay out of pocket, making its access limited. On the basis of data on the reduction of incidence of pneumococcal infections in people more than 64 years of age and children younger than two years, the World Health Organization (WHO) recommends incorporation of this vaccine in national vaccination programmes.