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Past Issue

Vol. 7, No. 5
Sep–Oct 2001

 
 
Synopsis

Cost-Effectiveness of a Potential Vaccine for Coccidioides immitis

Appendix II: Model Input Variables

Amber E. Barnato,* Gillian D. Sanders,† and Douglas K. Owens†‡
*University of Pittsburgh, Pittsburgh, Pennsylvania, USA; †Stanford University, Stanford, California, USA; and ‡VA Palo Alto Health Care System, Palo Alto, California, USA

 
 
Appendix II Table. Input variables, quality of data, and sourcesa
Input variable

Base-case estimate (range)

 Quality of evidenceb Source
Epidemiology (%)

Vaccine effectiveness

75 (20-90)

 I 2

Skin-test sensitivity

70 (50-80)

 II-2 3-5

Skin-test specificity

90 (70-97)

 II-2 4,6,7

Annual infection rate

2 (0.25-3)

 II-3 5,8-16

Annual emigration among vaccinees out of highly endemic region

0.5 (0-4.2)

 II-2, III c

Symptomatic primary pulmonary disease after infection

40

II-2 18

Diagnosed symptomatic primary pulmonary disease

10 (5-15)

III d

Death from primary pulmonary disease, given diagnosis

0.5 (0-26)

 II-2 19-22

Chronic pulmonary disease after diagnosed primary infection

5 (1-10)

 III 23-26

Death from chronic pulmonary disease

5 (0-20)

 III 24e

Dissemination after infection

0.38(0.25-0.55)

 II-2 17

Meningitis, given dissemination

33 (23-44)

 II-2 21,26

Death from meningeal dissemination

7 (5-40)

 II-2, III 27d,e

Moderate disability after meningeal dissemination

 50 (40-60) III 27d,e

Severe disability after meningeal dissemination

 17 (10-30) III 27d,e

Annual meningeal dissemination relapse rate, on treatment

 2 (0-5) I, II-2 28-30

Death from nonmeningeal dissemination

 2 (0-10) III e

Moderate disability after nonmeningeal dissemination

 33 (20-50) III d,e

Annual nonmeningeal dissemination relapse rate, On treatment

2 (0-5)

 I, II-2, III 4c

Off treatment

50 (35-65)

 I, II-2, III 31-34c

Mild vaccine side effects

25 (10-40)

 II-2 35

Vaccine anaphylaxis, x 10-4

1.67 (0.1-10)

 II-2 35
  
Direct medical costs ($)

Three doses of vaccine

180 (100-400)

 III 36,37

Skin test

12 (9-15)

 III 38

Home care, per month

2,450 (1,840-3,060)

 II-2 39

Diagnosed pulmonary disease

2,090 (1,570-2,610)

 II-2, III 40

Incident meningeal dissemination

9,510 (7,130-11,890)

 II-2 40

Medication and follow-up after Coccidioides immitis meningitis,f per month

1,510 (1,130-1,890)

 II-2 41e,g

Incident nonmeningeal dissemination

6,950 (5,210-8,690)

 II-2 40

Medication and follow-up for chronic pulmonary infection and nonmeningeal dissemination,f per month

530 (290-790)

 II-2 41e,g

Inpatient vaccine anaphylaxis treatment

2,180 (1,640-2,730)

 II-2 40
  

Time costsh

Average wage ($ per hour)

12 (9-15)

 II-2 d

Average clinic visit (hours)

1.25 (0.5-2)

 III Assumed

Lost work due to undiagnosed primary pulmonary disease (days)

5 (0-10)

 III Assumed

For parents of sick children (days)

3 (0-5)

 III Assumed
  
Utilities

Well

0.94 to 0.70i

 II-2 42

Diagnosed primary pulmonary infection

0.90 (0.85-0.95)

 III d

Chronic pulmonary infection (proxy, pulmonary tuberculosis)

0.57 (0.29-0.84)

 II-2, III 42

Meningeal dissemination (proxy, paraplegia)

0.40 (0.21-0.52)

 II-2, III 42

Nonmeningeal dissemination (proxy, orthopedic impairment)

0.59 (0.34-0.84)

 II-2, III 42

Severe disability after meningitis (proxy, hemiplegia)

0.27 (0.10-0.38)

 II-2, III 42

Moderate disability after meningitis (proxy, sciatica)

0.72 (0.52-0.92)

 II-2, III 42

Moderate disability after nonmeningeal dissemination (proxy, arthritis)

0.69 (0.51-0.92)

 II-2, III 42

Chronic azole treatment (proxy, warfarin treatment)

0.98 (0.92-1.0)

 II-2, III 43

Dead

0

 III Assumed

Vaccine side effect quality-of-life decrement (days)

0.1 (0-0.2)

 III Assumed
  
Other variables (%)

Discount rate

3 (0-5)

 III 44
aThe base-case estimate represents our best estimate for each value. All costs are in 2000 U.S. dollars.
bThe quality rating is derived from the U.S. Preventive Services Task Force Guide to Clinical Preventive Services (1). Source of evidence: I: at least one properly randomized controlled trial; II-1: well-designed controlled trial without randomization; II-2: well-designed cohort or case-control analytic studies; II-3: multiple time series with or without intervention; III: opinions of respected authorities; descriptive studies and case reports; or reports of expert committees (1).
cInternal Revenue Service, unpub. data.
dJohn Galgiani, pers. comm.
eHans Einstein, pers. comm.
fWe assumed that meningitis patients were treated with 800 mg of daily fluconazole, and chronic pulmonary and nonmeningeal dissemination patients with either 400 mg fluconazole or 400 mg ketoconazole daily (Royce Johnson, pers. comm., 1999). A 50:50 distribution of fluconazole and ketoconazole use represents our base case; the upper end of the range assumes all nonmeningeal dissemination patients receive fluconazole in follow-up, whereas the lower end assumes they receive the less expensive ketoconazole.
gRon Talbot, pers. comm.
hBased on a weighted adjusted gross income of $24,105 from taxpayers in the 10 highly endemic counties (Internal Revenue Service, unpub. data).
iMean HALex scores for healthy persons, by age group (when men and women had differing mean scores, we chose the higher of the two scores): <5=0.94; 5-17=0.93; 18-24= 0.92; 25-34=0.91; 35-44=0.90; 45-54=0.87; 55-64=0.81; 65-74=0.78; >75=0.70 (43).

  
 

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