Cost-Effectiveness Analysis of a Potential Vaccine to Prevent Colonization by Helicobacter Pylori in the South-European Context

OBJECTIVES: Several Helicobacter pylori vaccines are under development to prevent infection. Nevertheless, all of them are currently in preclinical stages. Our objective is to quantify the cost-effectiveness of such a vaccine in a local scenario.

METHODS: The evolution of a cohort of newborns was simulated through a compartmental model representing a series of clinical situations regarding H. pylori infection and its related diseases. The model was run under the assumption of vaccination in the first year of life and also under the assumption of no intervention. The model variables included transition parameters between compartments, costs and effectiveness of the vaccine, and costs of diseases caused by H. pylori and their impact on quality of life. The time horizon was set at 84 years (life expectancy) and the perspective of the health system was taken into account. Both deterministic and probabilistic approaches were used.

RESULTS: Vaccination against H. pylori would cost an average of €2,168/person more than no intervention. This would yield an average additional 0.32 quality-adjusted life years gained (QALY), which would entail an incremental cost-effectiveness ratio (ICER) of €7,196/QALY. For a willingness to pay of €24,506/QALY, 99.96% of the simulations are cost-effective at 84 years. This threshold is crossed 30 years after vaccination. The variables that carry the most weight in explaining the variability of the ICER are, in this order, vaccine effectiveness, the incidence of infection in young children, and the price of the vaccine. Vaccination would cease to be cost-effective with a price >€3,634/dose or with effective population coverage <11%.

CONCLUSIONS: When implemented in an environment with the epidemiological and economic characteristics of Southern Europe, a prophylactic vaccination against H. pylori would be cost-effective in the long run.