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Cost-effectiveness of measles control during elimination in Ontario, Canada, 2015
BACKGROUND: Given that measles is eliminated in Canada and measles immunisation coverage in Ontario is high, it has been questioned whether Ontario’s measles outbreak response is worthwhile. AIM: Our objective was to determine cost-effectiveness of measles containment protocols in Ontario from the h...
Autores principales: | , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
European Centre for Disease Prevention and Control (ECDC)
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6425553/ https://www.ncbi.nlm.nih.gov/pubmed/30892178 http://dx.doi.org/10.2807/1560-7917.ES.2019.24.11.1800370 |
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author | Ramsay, Lauren C Crowcroft, Natasha S Thomas, Shari Aruffo, Elena Teslya, Alexandra Heffernan, Jane M Gournis, Effie Hiebert, Joanne Jaeger, Valerie Jiaravuthisan, Manisa Sharron, Jennifer Severini, Alberto Deeks, Shelley L Gubbay, Jonathan Mazzulli, Tony Sander, Beate |
author_facet | Ramsay, Lauren C Crowcroft, Natasha S Thomas, Shari Aruffo, Elena Teslya, Alexandra Heffernan, Jane M Gournis, Effie Hiebert, Joanne Jaeger, Valerie Jiaravuthisan, Manisa Sharron, Jennifer Severini, Alberto Deeks, Shelley L Gubbay, Jonathan Mazzulli, Tony Sander, Beate |
author_sort | Ramsay, Lauren C |
collection | PubMed |
description | BACKGROUND: Given that measles is eliminated in Canada and measles immunisation coverage in Ontario is high, it has been questioned whether Ontario’s measles outbreak response is worthwhile. AIM: Our objective was to determine cost-effectiveness of measles containment protocols in Ontario from the healthcare payer perspective. METHODS: We developed a decision-analysis model comparing Ontario’s measles containment strategy (based on actual 2015 outbreak data) with a hypothetical ‘modified response’. The modified scenario assumed 10% response costs with reduced case and contact tracing and no outbreak-associated vaccinations; it was based on local and provincial administrative and laboratory data and parameters from peer-reviewed literature. Short- and long-term health outcomes, quality-adjusted life years (QALYs) and costs discounted at 1.5%, were estimated. We conducted one- and two-way sensitivity analyses. RESULTS: The 2015 outbreak in Ontario comprised 16 measles cases and an estimated 3,369 contacts. Predictive modelling suggested that the outbreak response prevented 16 outbreak-associated cases at a cost of CAD 1,213,491 (EUR 861,579). The incremental cost-effectiveness ratio was CAD 739,063 (EUR 524,735) per QALY gained for the outbreak response vs modified response. To meet the commonly accepted cost-effectiveness threshold of CAD 50,000 (EUR 35,500) per QALY gained, the outbreak response would have to prevent 94 measles cases. In sensitivity analyses, the findings were robust. CONCLUSIONS: Ontario’s measles outbreak response exceeds generally accepted cost-effectiveness thresholds and may not be the most efficient use of public health resources from a healthcare payer perspective. These findings should be balanced against benefits of increased vaccine coverage and maintaining elimination status. |
format | Online Article Text |
id | pubmed-6425553 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | European Centre for Disease Prevention and Control (ECDC) |
record_format | MEDLINE/PubMed |
spelling | pubmed-64255532019-04-17 Cost-effectiveness of measles control during elimination in Ontario, Canada, 2015 Ramsay, Lauren C Crowcroft, Natasha S Thomas, Shari Aruffo, Elena Teslya, Alexandra Heffernan, Jane M Gournis, Effie Hiebert, Joanne Jaeger, Valerie Jiaravuthisan, Manisa Sharron, Jennifer Severini, Alberto Deeks, Shelley L Gubbay, Jonathan Mazzulli, Tony Sander, Beate Euro Surveill Research BACKGROUND: Given that measles is eliminated in Canada and measles immunisation coverage in Ontario is high, it has been questioned whether Ontario’s measles outbreak response is worthwhile. AIM: Our objective was to determine cost-effectiveness of measles containment protocols in Ontario from the healthcare payer perspective. METHODS: We developed a decision-analysis model comparing Ontario’s measles containment strategy (based on actual 2015 outbreak data) with a hypothetical ‘modified response’. The modified scenario assumed 10% response costs with reduced case and contact tracing and no outbreak-associated vaccinations; it was based on local and provincial administrative and laboratory data and parameters from peer-reviewed literature. Short- and long-term health outcomes, quality-adjusted life years (QALYs) and costs discounted at 1.5%, were estimated. We conducted one- and two-way sensitivity analyses. RESULTS: The 2015 outbreak in Ontario comprised 16 measles cases and an estimated 3,369 contacts. Predictive modelling suggested that the outbreak response prevented 16 outbreak-associated cases at a cost of CAD 1,213,491 (EUR 861,579). The incremental cost-effectiveness ratio was CAD 739,063 (EUR 524,735) per QALY gained for the outbreak response vs modified response. To meet the commonly accepted cost-effectiveness threshold of CAD 50,000 (EUR 35,500) per QALY gained, the outbreak response would have to prevent 94 measles cases. In sensitivity analyses, the findings were robust. CONCLUSIONS: Ontario’s measles outbreak response exceeds generally accepted cost-effectiveness thresholds and may not be the most efficient use of public health resources from a healthcare payer perspective. These findings should be balanced against benefits of increased vaccine coverage and maintaining elimination status. European Centre for Disease Prevention and Control (ECDC) 2019-03-14 /pmc/articles/PMC6425553/ /pubmed/30892178 http://dx.doi.org/10.2807/1560-7917.ES.2019.24.11.1800370 Text en This article is copyright of the authors or their affiliated institutions, 2019. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution (CC BY 4.0) Licence. You may share and adapt the material, but must give appropriate credit to the source, provide a link to the licence, and indicate if changes were made. |
spellingShingle | Research Ramsay, Lauren C Crowcroft, Natasha S Thomas, Shari Aruffo, Elena Teslya, Alexandra Heffernan, Jane M Gournis, Effie Hiebert, Joanne Jaeger, Valerie Jiaravuthisan, Manisa Sharron, Jennifer Severini, Alberto Deeks, Shelley L Gubbay, Jonathan Mazzulli, Tony Sander, Beate Cost-effectiveness of measles control during elimination in Ontario, Canada, 2015 |
title | Cost-effectiveness of measles control during elimination in Ontario, Canada, 2015 |
title_full | Cost-effectiveness of measles control during elimination in Ontario, Canada, 2015 |
title_fullStr | Cost-effectiveness of measles control during elimination in Ontario, Canada, 2015 |
title_full_unstemmed | Cost-effectiveness of measles control during elimination in Ontario, Canada, 2015 |
title_short | Cost-effectiveness of measles control during elimination in Ontario, Canada, 2015 |
title_sort | cost-effectiveness of measles control during elimination in ontario, canada, 2015 |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6425553/ https://www.ncbi.nlm.nih.gov/pubmed/30892178 http://dx.doi.org/10.2807/1560-7917.ES.2019.24.11.1800370 |
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