Retrospective Cost-Effectiveness Analyses for Polio Vaccination in the United States
by Kimberly M. Thompson and Radboud J. Duintjer Tebbens, Risk Analysis 2006;26(6):1423-1440

Press Release - January 19, 2007
Press coverage - Coverage of this paper included an AAAS Science Update and an article in the Harvard Public Health Review.

Abstract

The history of polio vaccination in the United States spans 50 years and includes different phases of the disease, multiple vaccines, and a sustained significant commitment of resources. We estimated cost-effectiveness ratios and assessed the net benefits of polio vaccination applicable at various points in time from the societal perspective and we discounted these back to appropriate points in time. We reconstructed vaccine price data from available sources and used these to retrospectively estimate the total costs of the U.S. historical polio vaccination strategies (all costs reported in year 2002 dollars). We estimate that the United States invested approximately US dollars 35 billion (1955 net present value, discount rate of 3%) in polio vaccines between 1955 and 2005 and will invest approximately US dollars 1.4 billion (1955 net present value, or US dollars 6.3 billion in 2006 net present value) between 2006 and 2015 assuming a policy of continued use of inactivated poliovirus vaccine (IPV) for routine vaccination. The historical and future investments translate into over 1.7 billion vaccinations that prevent approximately 1.1 million cases of paralytic polio and over 160,000 deaths (1955 net present values of approximately 480,000 cases and 73,000 deaths). Due to treatment cost savings, the investment implies net benefits of approximately US dollars 180 billion (1955 net present value), even without incorporating the intangible costs of suffering and death and of averted fear. Retrospectively, the U.S. investment in polio vaccination represents a highly valuable, cost-saving public health program. Observed changes in the cost-effectiveness ratio estimates over time suggest the need for living economic models for interventions that appropriately change with time. This article also demonstrates that estimates of cost-effectiveness ratios at any single time point may fail to adequately consider the context of the investment made to date and the importance of population and other dynamics, and shows the importance of dynamic modeling.

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Background on polio

What are the study’s main findings?

• The history of polio vaccination in the U.S. spans over 50 years and includes different phases of the disease, multiple vaccines, and a sustained significant commitment of financial resources.
• The U.S. invested over $35 billion between 1955 and 2005 and will continue to invest billions into the future to pay for polio vaccination. These historical and future investments translate into over 1.7 billion vaccinations that prevent approximately 1.1 million cases of paralytic polio and over 160,000 deaths, thus saving Americans hundreds of billions of dollars in treatment costs.
• Due to treatment cost savings, the investment implies net benefits of approximately $180 billion (1955 net present value), even without incorporating the intangible costs of suffering and death and of averted fear.
• Observed changes in the cost-effectiveness ratio estimates over time suggest the need for living economic models for interventions that appropriately change with time.
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• This study should help people understand and better appreciate the huge economic savings that can come from investments in public health interventions.
• Analysts should use dynamic models to correctly capture the benefits of vaccination against infectious diseases in their economic evaluations.
• In interpreting cost-effectiveness ratios, policy makers should consider the larger context of the investment made to date.
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