CDC -- through the Advisory COmmitee on Immunization Practices -- which recommends what vaccines will be covered by the government and health plans under the new health law -- has decided that new vaccines for meningitis that prevents thousands of cases where children are maimed and hundreds of deaths each year isn't worth it. A study by the Dr. Chris Stomberg of Bates-White Economic Consulting entitled: Policy Priorities and the Value of Life raises some disturbing questions that Congress should focus on.
Dr. Stomberg writes:
"In contrast to its Medicare program, the government makes life and death decisions at the other end of the age scale, guided in part by cost considerations. In fact, the CDC has come to explicitly consider cost-effectiveness studies when setting nationwide childhood immunization policy.
When the first meningococcal vaccine for adolescents (ages 11 to 55) was approved by the FDA in 2005, CDC promptly included it on the routine vaccine schedule. ACIP’s recommendation at that time was supported, in part, by information found in a cost-effectiveness study (Shepard et al. 2005)
that was led by a team of investigators from the CDC and published in the journal Pediatrics.
Cases Deaths QALYS Cost per
Averted Averted Gained QALY Gained
This study estimated the benefits in terms of deaths averted, cases averted, and QALYs gained if the meningococcal vaccine were administered to three different populations: adolescent, toddler and infant.....the study actually found that the greatest benefits would be accrued by
administering a meningococcal vaccine to the infant population, and the lowest cost per QALY would the fact that prior studies In early 2010, after it reviewed the results of a cost-effectiveness study of meningococcal vaccine for infants, ACIP continued to hold its position against including any of the forthcoming infant vaccines in its routine recommendations once approved by FDA.
In Aril 2011, the FDA approved the first meningococcal vaccine for infants, with other products on the horizon for this age group as well. A
routine recommendation for infant use of meningitis vaccines has not yet been made.What this example highlights is the importance of cost in the CDC’s deliberations over its infant meningitis immunization recommendations. It provides an interesting counterpoint to Medicare’s decision to continue coverage of Avastin. While Medicare has elected to continue covering the use of a drug for which the FDA has withdrawn approval, CDC has refrained from recommending (and paying for) the use of an FDA-approved vaccine. Whether intentional or not, there is apparently a deep divide in how the government thinks about healthcare spending at the two ends of the age spectrum. With no consistent method for evaluating health programs, this is to be expected. "
You can read the entire paper here.