Informing decision makers seeking to improve vaccination programs: case-study Serbia

Figures & data

Figure 1. Decision tree structure to model rotavirus, varicella or pneumococcal disease

Table 1. Summary of data inputs for vaccine interventions

Parameter	Pneumococcus meningitis	Pneumococcus bacteraemia	All-cause pneumonia	All-cause AOM, excl. myringotomy	AOM myringotomy	Rotavirus	Varicella
Incidence of each disease (%) by age-group (years)
0–1	0.005351	0.009349	0.194662	1.08976	0.0165953	3.118997	1.639310
1–2	0.005351	0.009349	0.302069	1.07557	0.0163793	6.136418	5.634038
2–3	0.001856	0.003244	0.302723	1.14976	0.0175091	6.149711	5.646243
3–4	0.001856	0.003244	0.300842	1.28544	0.0195753	3.650648	5.611147
4–5	0.001856	0.003244	0.300500	0.85599	0.0130353	3.646502	5.604774
Reference	[26]	[26]	[27,28]	^b	^b	[29,30]	[27]
Healthcare resource utilisation assumptions per type of severity event^a
Moderate (GP visit rate)	0	0	2.5	2.5	3	2	2
Severe (hospitalisation)	1	1	0.1	0.1	1	0.1	0.05
Hospitalisation days/event	10	10	10	10	3	4.58	5
Case fatality rates (%)
	4[^31]	2.3^[Citation31]	1^[Citation31]	0	0	0.003^[32]	0.0005^[33]
Disutility per case (adjusted for duration)
Disutility/case	0.023^[34]	0.008^[34]	0.006^[34]	0.005^[35]	0.005^[35]	0.006^[36]	0.004^[37]
Vaccine efficacy
Maximum % (CI)	79.0 (74.0–83.0)^[38]	79.0 (74.0–83.0)^[38]	18.0 (6.0–29.0)^[38]	24.0 (9.0–37.0)^[38]	13.0 (−2.0–26.0)^[38]	79.0 (73.0–84.0)^[39]	95.0 (93.6–96.2)^[40]
Age at which it starts (months)	4	4	4	4	4	2	12
Unit costs (RSD)
GP visit^[41]	NA	NA	284.01	284.01	284.01	284.01	284.01
Hospital day^[42]	1545.50	1545.50	1545.50	1545.50	1545.50	1545.50	1545.50
Vaccination course/child (2018)	9921.72^23					12,393.00^[43]	6918.80^[23]

^aExpert opinion.

AOM: Acute otitis media; CI: 95% Confidence interval; GP: General practitioner; NA: Not applicable; RSD Serbian Dinar

Table 2. The ranking of vaccine interventions when optimising the sequence of vaccine introduction by specific criteria

Criteria	PCV	RV vaccine	VZV vaccine	Reduction of outcome over 5 years (compared with no vaccine)
Cases	3	2	1	32,327 (−18.7%)
GP visits	3	2	1	64,777 (−18.2%)
Hospitalisation days	3	1	2	10,175 (−13.3%)
Deaths	1	2	3	3.94 (−7.6%)
QALYs lost	3	2	1	149.7 (−16.2%)
Disease management costs	3	2	1	RSD 21,679,630 (−17.7%)

GP: General practitioner; PCV: Pneumococcal conjugate vaccine; QALY: Quality adjusted life year; RSD: Serbian Dinar; RV: Rotavirus; VZV: Varicella zoster virus.

Figure 2. Optimal sequence of vaccine introductions for maximum gain in (a) deaths prevented, (b) QALY loss minimised and (c) hospitalisation stays minimised, under budget constraint

QALY: Quality adjusted life year; RSD: Serbian Dinar.

Figure 3. Optimal sequence of vaccine introductions for maximum gain in (a) deaths prevented, (b) QALY loss minimised under constrained budget and vaccination coverage

RSD: Serbian Dinar.

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