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The Cost-effectiveness of Vaccination Against Lyme Disease
Nancy A. Shadick, MD, MPH;
Matthew H. Liang, MD, MPH;
Charlotte B. Phillips, MPH;
Karin Fossel, MA;
Karen M. Kuntz, ScD
Arch Intern Med. 2001;161:554-561.
Background Vaccination against Lyme disease appears to be safe and effective; however,
the cost per quality-adjusted life-year (QALY) gained with vaccination is
unknown.
Methods We developed a decision-analytic model to evaluate the cost-effectiveness
of vaccination compared with no vaccination in individuals living in endemic
areas of Lyme disease. Our analysis encompassed a 10-year time horizon including
a 2-year vaccination schedule with an additional year of vaccine effectiveness.
The costs and probabilities of vaccination risk, compliance and efficacy,
and Lyme disease clinical sequelae and treatment were estimated from the literature.
Health-related quality-of-life weights of the various clinical sequelae of
Lyme disease infection were obtained from a sample of 105 residents from Nantucket
Island, Massachusetts.
Results Vaccinating 10 000 residents living in endemic areas with a probability
of Lyme disease per season of 0.01 averted 202 cases of Lyme disease during
a 10-year period. The additional cost per QALY gained compared with no vaccination
was $62 300. Vaccination cost $12 600/QALY gained for endemic areas
with an attack rate of 2.5% per season, and $145 200/QALY gained for
an attack rate of 0.5%. Vaccinating individuals over an accelerated 2-month
vaccination schedule improved the cost-effectiveness to $53 700/QALY
gained. If a yearly booster shot is required for persisting efficacy, the
marginal cost-effectiveness ratio increases to $72 700/QALY. The cost-effectiveness
of vaccination was most sensitive to the Lyme disease treatment efficacy and
assumptions about the persistence of vaccination effect.
Conclusion Vaccination against Lyme disease appears only to be economically attractive
for individuals who have a seasonal probability of Borrelia
burgdorferi infection of greater than 1%.
From the R. B. Brigham Multipurpose Arthritis and Musculoskeletal Diseases
Center (Drs Shadick and Liang and Mss Phillips and Fossel), the Department
of Medicine, Division of General Medicine and Primary Care (Drs Liang and
Kuntz), Division of Rheumatology, Immunology and Allergy (Drs Shadick and
Liang), Brigham and Women's Hospital, Harvard Medical School, and the Department
of Health Policy and Management (Dr Kuntz), Harvard School of Public Health,
Boston, Mass. Dr Shadick has received research support from SmithKline Beecham.
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