Childhood vaccination against pneumococcal otitis media and pneumonia: an analysis of benefits and costs.

OBJECTIVE: To examine the economic benefits and costs of routine vaccination of children younger than 5 years of age against pneumococcal otitis media and pneumonia with the pneumococcal conjugate vaccine.

STUDY DESIGN: A decision-analytic model of the cumulative numbers of cases and costs to age 10 years of acute otitis media (AOM), tympanostomy and related procedures (TRP), and community-acquired pneumonia (CAP) in children who either did or did not receive the pneumococcal conjugate vaccine.

PATIENTS AND METHODS: Seven hypothetical cohorts of 1000 children, stratified by age at initial vaccination, were followed. Outcome measures include costs of vaccination, cumulative numbers of cases of AOM, TRP, and CAP to age 10 years, and related disease costs, including medical treatment and parental work loss.

RESULTS: Routine vaccination of 1000 children against pneumococcal infection would cost between $57,000 and $226,000, depending on age (the recommended number of doses varies by age at initial vaccination). Acute otitis media, TRP, and CAP to age 10 years would decline by 139 to 330, 8 to 22, and 15 to 30 cases, respectively; costs of medical treatment and work loss would correspondingly decline by $56,000 to $138,000. Expected net economic benefits (benefits minus costs) of vaccination against pneumococcal otitis media and pneumonia range from -$88,000 to $15,000 for children less than 2 years of age, and from -$1,000 to $31,000 for those aged 2 to 5 years at vaccination.

CONCLUSION: Routine vaccination against pneumococcal otitis media and pneumonia appears to be cost-increasing for children less than 2 years of age who require multiple doses, but cost-saving for children aged 2 to 5 years who would require only a single dose of the vaccine.