Preferences for health outcomes associated with Group A Streptococcal disease and vaccination
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RESEARCH
Open Access
Preferences for health outcomes associated with Group A Streptococcal disease and vaccination Grace M Lee1,2*, Joshua A Salomon3, Charlene Gay1, James K Hammitt4
Abstract Background: A 26-valent Group A Streptococcus (GAS) vaccine candidate has been developed that may provide protection against pharyngitis, invasive disease and rheumatic fever. However, recommendations for the use of a new vaccine must be informed by a range of considerations, including parents’ preferences for different relevant health outcomes. Our objectives were to: (1) describe parent preferences for GAS disease and vaccination using willingness-to-pay (WTP) and time trade-off (TTO) methods; and (2) understand how parents’ implied WTP for a quality-adjusted life year (QALY) gained might vary depending on the particular health outcome considered (e.g. averted GAS disease vs. vaccine adverse events). Methods: Telephone interviews were conducted with parents of children diagnosed with GAS pharyngitis at 2 pediatric practice sites in the Boston metropolitan area. WTP and TTO (trading parental longevity for child’s health) questions for 2 vaccine and 4 disease-associated health states were asked using a randomly selected opening bid, followed by a 2nd bid and a final open-ended question about the amount willing to pay or trade. Descriptive analyses included medians and interquartile ranges for WTP and TTO estimates. The Wilcoxon signed-rank test was used to assess differences in WTP/QALY values for vaccine adverse events vs. disease states. Results: Of 119 respondents, 100 (84%) and 96 (81%) provided a complete set of responses for WTP and TTO questions, respectively. The median WTP and discounted (at 3% per year) TTO values to avoid each health state were as follows: local reaction, $30, 0.12 days; systemic reaction, $50, 0.22 days; impetigo, $75, 1.25 days; strep throat, $75, 2.5 days; septic arthritis, $1,000, 6.6 days; and toxic shock syndrome, $3,000, 31.0 days. The median WTP/QALY was significantly higher for vaccine adverse events (~$60,000/QALY) compared to disease states ($18,000 to $36,000/QALY). Conclusions: Parents strongly prefer to prevent GAS disease in children compared to vaccine adverse events. However, implied WTP/QALY ratios were higher for the prevention of vaccine adverse events. Regret for errors of commission vs. omission may differ and should be considered by vaccine policymakers.
Background Group A Streptococcus (GAS) is responsible for up to 2.6 million cases of pharyngitis in children each year and 1.1 million cases in adults in the U.S., with an estimated economic burden of $224-539 million annually due to GAS pharyngitis [1,2]. In addition, infection with GAS causes up to 9,700 cases of invasive disease and 1,300 deaths annually [3,4]. The clinical spectrum of invasive GAS disease is broad and may include bacteremia, pneumonia, septic arthritis, osteomyelitis,
* Correspondence: [email protected] 1 Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Instit
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