COST-EFFECTIVENESS ANALYSIS OF H5N1 CLADE 1 PREPANDEMIC VACCINATION AMONG COMMERCIAL BROILER OPERATION EMPLOYEES Open Access

Abstract

Objectives: Economic evaluation of a prepandemic H5N1 clade 1 vaccination policy among commercial
broiler operation (CBO) employees
Methods: Cost-effectiveness analysis (CEA) of a decision tree model considering the societal
perspective. Model inputs primarily were from published sources. The probabilistic model, adjusted for
various case-fatality scenarios, was evaluated at varying levels of immunization coverage, vaccine
efficacy and infection levels.
Results: The CE ratio (Cost per QALY) decreased as the immunization coverage of prepandemic H5N1
clade 1 increased among commercial broiler operation (CBO) employees. The 100% vaccination
coverage dominated the alternative policies (0%, 25%, 50% and 75% vaccination coverage) at vaccine
efficacy and infection levels in low (0.02%), moderate (1.08%) and high (59%) case-fatality scenarios.
Conclusion: Prepandemic H5N1 clade 1 vaccination is a viable option for CBO employees even when
allowing for the lowest infection level and lowest vaccine efficacy in low, moderate and high case-fatality
scenarios.
Keywords: cost-effectiveness analysis, H5N1, vaccines

Table of Contents

Table of Contents

Introduction 8

Methods 11

Results 15

Discussion 19

Conclusion 21

References 22

List of Figures

Figure 1, Conceptual Model 10

Figure 2, Structure of Decision Tree models 11

Figure 3, CE ratio with varying infection level (10%-90%) in vaccination coverage (0%-100%) 17

Figure 4, CE ratio with varying vaccine efficacy (34%-55%) in vaccination coverage (0%-100%) 18

List of Tables

Table 1, Decision Tree Model Variables 13

Table 2, Decision Tree Model Variable Assumptions and Limitations 14

Table 3, Incremental CE ratio (Cost per QALY) for CE ratio vs. Infection 17

Table 4, Incremental CE ratio (Cost per QALY) for CE ratio vs. Vaccine efficacy 18

Appendices

Appendix A, Review of Literature 26

Influenza A viruses 26

H5N1: an Influenza A Subtype 27

H5N1 and Commercial Broiler Operations (CBO) 28

H5N1 Policies 29

H5N1 Vaccines 30

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Career Masters of Public Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	cost-effectiveness analysis, H5N1, vaccines
Committee Chair / Thesis Advisor	Omer, Saad B, Emory University
Committee Members	Yang, Zhou, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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