Public health impact and return on investment of Belgium's pediatric immunization program.

We evaluated the public health impact and return on investment of Belgium's pediatric immunization program (PIP) from both healthcare-sector and societal perspectives. We developed a decision analytic model for 6 vaccines routinely administered in Belgium for children aged 0-10 years: DTaP-IPV-HepB-Hib, DTaP-IPV, MMR, PCV, rotavirus, and meningococcal type C. We used separate decision trees to model each of the 11 vaccine-preventable pathogens: diphtheria, tetanus, pertussis, poliomyelitis, Across all 11 pathogens, we estimated that the PIP prevented 226,000 cases of infections and 200 deaths, as well as the loss of 7,000 life-years and 8,000 quality-adjusted life-years over the lifetime of a birth cohort of 118,000 children. The PIP was associated with discounted vaccination costs of €91 million from the healthcare-sector perspective and €122 million from the societal perspective. However, vaccination costs were more than fully offset by disease-related costs averted, with the latter amounting to a discounted €126 million and €390 million from the healthcare-sector and societal perspectives, respectively. As a result, pediatric immunization was associated with overall discounted savings of €35 million and €268 million from the healthcare-sector and societal perspectives, respectively; every €1 invested in childhood immunization resulted in approximately €1.4 in disease-related cost savings to the health system and €3.2 in cost savings from a societal perspective for Belgium's PIP. Estimates of the value of the PIP were most sensitive to changes in input assumptions for disease incidence, productivity losses due to disease-related mortality, and direct medical disease costs. Belgium's PIP, which previously had not been systematically assessed, provides large-scale prevention of disease-related morbidity and premature mortality, and is associated with net savings to health system and society. Continued investment in the PIP is warranted to sustain its positive public health and financial impact.

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Copyright © 2023 Carrico, Mellott, Talbird, Bento-Abreu, Merckx, Vandenhaute, Benchabane, Dauby, Ethgen, Lepage, Luyten, Raes, Simoens, Van Ranst, Eiden, Nyaku and Bencina.

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JC, CM, and ST are employed by RTI Health Solutions, which received funding for the conduct of this study. AB-A, BM, JV, and DB are employees of MSD, Belgium. GB is an employee of MSD, Spain. AE is an employee of Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA. MN was an employee of Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, while this study was conducted. GB, AE, and MN are shareholders in Merck & Co., Inc., Rahway, NJ, USA. SS has been involved in research and advisory boards related to the economic evaluation of vaccines funded by MSD, GSK, and Pfizer. ND reports personal fees from Roche and Boehringer-Ingelheim and nonfinancial support from Pfizer, Janssen, and MSD outside the submitted work; ND also has been involved in research related to the economic evaluation of vaccines with MSD and Pfizer as an unpaid consultant. PL has received consulting fees for advisory board participation from Sanofi. OE has received consulting fees for advisory board participation and for support of model design in the evaluation of vaccines from MSD, Pfizer, GSK, and Sanofi. JL’s employer (KU Leuven) has received an hourly wage compensation for participation in workshops related to the economic evaluation of vaccines funded by MSD and Pfizer.