Cost-effectiveness of vaccination against cytomegalovirus (CMV) in adolescent girls to prevent infections in pregnant women living in France

D S N'Diaye; O Launay; O Picone; V Tsatsaris; E Azria; F Rozenberg; M Schwarzinger; Y Yazdanpanah

doi:10.1016/j.vaccine.2018.01.042

Cost-effectiveness of vaccination against cytomegalovirus (CMV) in adolescent girls to prevent infections in pregnant women living in France

Vaccine. 2018 Feb 28;36(10):1285-1296. doi: 10.1016/j.vaccine.2018.01.042. Epub 2018 Feb 1.

Authors

D S N'Diaye¹, O Launay², O Picone³, V Tsatsaris⁴, E Azria⁵, F Rozenberg⁶, M Schwarzinger⁷, Y Yazdanpanah⁸

Affiliations

¹ INSERM, IAME, UMR 1137, UFR de Médecine, 75018 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Paris, France. Electronic address: ndiayedieyanaba@hotmail.fr.
² Department of Infectious Diseases, CIC Cochin-Pasteur, Cochin Broca Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; INSERM U 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France; INSERM CIC 1417, Paris, France. Electronic address: odile.launay@aphp.fr.
³ Service de gynécologie obstétrique et médecine de la reproduction, hôpital Foch, 40, rue Worth, 92150 Suresnes, France; EA2493, UFR des sciences de la santé Simone-Veil, UVSQ, 78180 Montigny-le-Bretonneux, France. Electronic address: olivier.picone@aphp.fr.
⁴ Port Royal Maternity, Department of Gynecology Obstetrics I, Centre Hospitalier Universitaire Cochin Broca Hôtel Dieu, Groupe Hospitalier Universitaire Ouest, Assistance Publique-Hôpital de Paris, Paris, France; INSERM, UMR-S 1139, Paris, France; PRES Sorbonne Paris Cité, Université Paris Descartes, Paris, France. Electronic address: tsatsaris@cch.aphp.fr.
⁵ Department of Obstetrics, Groupe Hospitalier Paris Saint Joseph, Paris Descartes University, Paris, France; Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France. Electronic address: eazria@hpsj.fr.
⁶ Assistance Publique des Hôpitaux de Paris, Virology, Pathology and Dermatology Departments, Hôpital Cochin, 27, rue du Fbg Saint-Jacques, 75679 Paris cedex 14, France; Université Paris Descartes et Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Service de Virologie, Paris, France; Institut Cochin, Inserm U1016, Université Paris Descartes, 22 rue Méchain, 75014 Paris, France. Electronic address: flore.rozenberg@aphp.fr.
⁷ INSERM, IAME, UMR 1137, UFR de Médecine, 75018 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Paris, France. Electronic address: michael.schwarzinger@transhealthecon.net.
⁸ INSERM, IAME, UMR 1137, UFR de Médecine, 75018 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Infectious Diseases Department, Bichat-Claude Bernard Hospital, Paris, France. Electronic address: yazdan.yazdanpanah@aphp.fr.

PMID: 29397227
DOI: 10.1016/j.vaccine.2018.01.042

Abstract

Background: CMV infections are the most frequent congenital infections worldwide.

Aim: Assess the cost-effectiveness of vaccination strategies of adolescent girls vs. current practice (hygiene counseling) to prevent CMV seroconversions during pregnancy in France.

Method: A Markov decision-tree model simulated overtime the trajectory of a single fictive cohort of 390,000 adolescent women aged 14 years old, living in France. Impact of vaccination was explored until the end of their reproductive live 40 years later. STRATEGIES COMPARED: "S1: No vaccination" (current practice); "S2: Routine vaccination"; "S3: Screening and vaccination of the seronegative".

Model parameters: Seroconversion rate without vaccination (0.035%/pregnant woman-week); fetal transmission risk (41%). Vaccine vs. no vaccination: a 50% decrease in maternal seroconversions.

Outcomes: Quality-Adjusted Life-Years (QALYs) of the cohort-born babies; discounted costs; Incremental Cost-Effectiveness Ratio (ICER).

Results: S2 was the most effective strategy (with 35,000 QALYs gained) and the most expensive (€211,533,000); S1 was the least effective and least costly (€75,423,000). ICERs of strategy S3 vs. S1, and S2 vs. S3 were 6,000€/QALY gained (95% uncertainty range [2700-13,300]) and 16,000€/QALY [negative ICER (S3 dominated by S2) - 94,000] gained, respectively; highly cost-effective because ICER < 1∗France's GPD/capita = €30,000.

Sensitivity analysis: If the seroprevalence was >62% (vs. 20% in the base case), S3 would become the most efficient strategy.

Conclusion: In France, systematic vaccination of adolescent girls was the most efficient strategy to prevent maternal seroconversions. If the population was less than 62% immune, systematic screening and vaccination of susceptibles would become the most cost-effective approach.

Keywords: Cost-effectiveness; Cytomegalovirus; Modeling; Pregnancy; Screening; Vaccination.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Cost-Benefit Analysis*
Cytomegalovirus / immunology*
Female
France / epidemiology
Health Care Costs
Humans
Incidence
Infectious Disease Transmission, Vertical
Markov Chains
Outcome Assessment, Health Care
Papillomavirus Infections / epidemiology*
Papillomavirus Infections / prevention & control*
Papillomavirus Infections / transmission
Papillomavirus Vaccines / administration & dosage
Papillomavirus Vaccines / economics
Papillomavirus Vaccines / immunology*
Pregnancy
Public Health Surveillance
Sex Factors
Vaccination* / economics
Vaccination* / methods

Substances

Papillomavirus Vaccines