TY - JOUR
T1 - Influenza and pneumococcal vaccination of HIV-infected patients
T2 - A policy analysis
AU - Rose, David N.
AU - Schechter, Clyde B.
AU - Sacks, Henry S.
N1 - Funding Information:
From the Departments of Medicine (DNR, CBS. HSS), Community Medicine (DNR, CBS, HSS), and Biomathematical Sciences (HSS), the AIDSCenter (DNR). and the ClinicalTrials Unit (HSS), Mount Sinai School of Medicine, New York, New York. Requests for reprints should be addressed to David N. Rose, M.D., Box 1009, Mount Sinai Medical Center, New York, New York 10029. This work was presented in part at the Seventh International Conference on AIDS, Florence, June 1991. This work was supported in part by the following grants: l/R01 MH4SSSSfrom the National lnstiiute of Mental Health, and UOl-Al27667 and UOl Al27554fr om the National Institute of Allergy and Infectious Diseases. Manuscript submitted December 30. 1991.and accepted in revised form September B,l992.
PY - 1993/2
Y1 - 1993/2
N2 - Objective: To analyze the policy of vaccinating human immunodeficiency virus (HTV)-infected young adults against influenza and pneumococcal infections. Methods: Transition state model of clinical immune deterioration of HIV infection, published data, and experts' estimates for the uncertain variables. Outcome measures are the number of influenza and pneumococcal infection hospitalizations and deaths prevented over 10 years and cost-effectiveness ratios. Patients: Hypothetical cohort of HIV-infected 30-year-old patients. Results: Although pneumococcal vaccine effectiveness diminishes with advanced HIV disease, the risks of pneumococcal infection rise substantially. Pneumococcal vaccination was therefore found to be a reasonable prevention strategy at all HIV disease stages: few vaccinations are needed to prevent hospitalizations and deaths, and the vaccination strategy is cost-effective. By contrast, influenza incidence is low among young adults, and HIV-related immunodeficiency increases influenza risks only minimally. Because the vaccine is administered yearly, many more vaccinations must be administered and fewer hospitalizations and deaths are prevented than with pneumococcal vaccination. The costs to extend life expectancy are high, and beyond the costs of other prevention strategies for persons with moderate to severe immunodeficiency. Conclusion: Pneumococcal vaccination is a reasonable prevention strategy for HIV-infected patients at all stages of immunodeficiency. Fewer hospitalizations and deaths are prevented by influenza vaccination, making it a far less cost-effective prevention strategy than pneumococcal vaccination.
AB - Objective: To analyze the policy of vaccinating human immunodeficiency virus (HTV)-infected young adults against influenza and pneumococcal infections. Methods: Transition state model of clinical immune deterioration of HIV infection, published data, and experts' estimates for the uncertain variables. Outcome measures are the number of influenza and pneumococcal infection hospitalizations and deaths prevented over 10 years and cost-effectiveness ratios. Patients: Hypothetical cohort of HIV-infected 30-year-old patients. Results: Although pneumococcal vaccine effectiveness diminishes with advanced HIV disease, the risks of pneumococcal infection rise substantially. Pneumococcal vaccination was therefore found to be a reasonable prevention strategy at all HIV disease stages: few vaccinations are needed to prevent hospitalizations and deaths, and the vaccination strategy is cost-effective. By contrast, influenza incidence is low among young adults, and HIV-related immunodeficiency increases influenza risks only minimally. Because the vaccine is administered yearly, many more vaccinations must be administered and fewer hospitalizations and deaths are prevented than with pneumococcal vaccination. The costs to extend life expectancy are high, and beyond the costs of other prevention strategies for persons with moderate to severe immunodeficiency. Conclusion: Pneumococcal vaccination is a reasonable prevention strategy for HIV-infected patients at all stages of immunodeficiency. Fewer hospitalizations and deaths are prevented by influenza vaccination, making it a far less cost-effective prevention strategy than pneumococcal vaccination.
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U2 - 10.1016/0002-9343(93)90178-r
DO - 10.1016/0002-9343(93)90178-r
M3 - Article
C2 - 8094271
AN - SCOPUS:0027502269
SN - 0002-9343
VL - 94
SP - 160
EP - 168
JO - American Journal of Medicine
JF - American Journal of Medicine
IS - 2
ER -