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Vaccines for the 21st Century: A Tool for Decisionmaking (2000)

Chapter: Appendix 19: Parainfluenza Virus

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Suggested Citation:"Appendix 19: Parainfluenza Virus." Institute of Medicine. 2000. Vaccines for the 21st Century: A Tool for Decisionmaking. Washington, DC: The National Academies Press. doi: 10.17226/5501.
×

APPENDIX 19
Parainfluenza Virus

DISEASE BURDEN

Epidemiology

For the purposes of the calculations in this report, the committee estimated that there are 2.5 million cases of parainfluenza virus (PIV) infection each year in the United States in children under 2 years of age. An additional 3.5 million infections occur in people greater than 2 years of age (25% of those in people 65 years of age or older). It is also assumed that there are 300 deaths per year in children 2 years of age and under and 140 deaths in people 65 years of age and older due to PIV disease.

Disease Scenarios

For the purposes of the calculation in this report, the committee assumed that PIV disease manifests as either a mild infection such as pharyngitis or otitis media, croup, or bronchiolitis/pneumonia. It was assumed that in children 2 years of age and under, the proportion of infections manifesting as those 3 disease scenarios is 70%, 20%, and 10% respectively. For people 2 years of age and older, it was assumed that the distribution is 90% as pharyngitis and 10% as bronchiolitis and pneumonia. The health utility index associated with PIV disease ranges from 0.9 (7 days of pharyngitis) to .5 (7 days of either croup or bronchiolitis). See Table A19–1.

Suggested Citation:"Appendix 19: Parainfluenza Virus." Institute of Medicine. 2000. Vaccines for the 21st Century: A Tool for Decisionmaking. Washington, DC: The National Academies Press. doi: 10.17226/5501.
×

Table A19–1 Disease Scenarios for Parainfluenza Virus Infection

 

% of Cases

Committee HUI Values

Duration (years)

Upper Respiratory

70.00%

 

pharyngitis, otitis media

 

0.90

0.0192 (7 days)

Croup

19.20%

 

outpatient only

 

0.75

0.0274 (10 days)

Croup

0.80%

 

inpatient

 

0.50

0.0192 (7 days)

outpatient

 

0.75

0.0082 (3 days)

Bronchiolitis/pneumonia

9.60%

 

outpatient only

 

0.75

0.0274 (10 days)

Bronchiolitis/pneumonia

0.40%

 

inpatient

 

0.50

0.0192 (7 days)

outpatient

 

0.75

0.0082 (3 days)

Upper Respiratory

90.00%

0.90

0.0192 (7 days)

Bronchiolitis/pneumonia

10.00%

0.75

0.0274 (10 days)

Upper Respiratory

90.00%

0.90

0.0192 (7 days)

Bronchiolitis/pneumonia

9.60%

0.75

0.0274 (10 days)

Bronchiolitis/pneumonia

0.40%

 

inpatient

 

0.50

0.0192 (7 days)

outpatient

 

0.75

0.0082 (3 days)

COST INCURRED BY DISEASE

Table A19–2 summarizes the health care costs incurred by PIV infections. For the purposes of the calculations in this report, it was assumed that all children 2 years of age and under with PIV disease receive medical treatment. It was assumed that only 50% of people between the ages of 2 and 64 receive treatment for PIV disease. It was also assumed that only 50% of people 65 years of age and older receive treatment for mild (requiring only outpatient treatment if treated) pharyngitis and bronchiolitis. A small number of people age 65 years of age and older are hospitalized for bronchiolitis and pneumonia.

Pharyngitis, otitis media, croup, and outpatient treatment of bronchiolitis/pneumonia were assumed to be associated with physician visits, diagnostics and medications. The more serious disease incurred more visits to the physician. Hospitalization costs are included for the small number of people with PIV disease who require it.

Suggested Citation:"Appendix 19: Parainfluenza Virus." Institute of Medicine. 2000. Vaccines for the 21st Century: A Tool for Decisionmaking. Washington, DC: The National Academies Press. doi: 10.17226/5501.
×

Table A19–2 Costs of Care for Parainfluenza Virus Infection

 

% with Care

Cost per Unit

Units per Case

Form of Treatment

AGE<2

 

Upper Respiratory

 

pharyngitis, otitis media

100%

$50

1.0

physician a

 

100%

$50

1.0

diagnostic a

100%

$50

1.0

medication b

Croup

 

outpatient only

100%

$50

2.0

physician a

 

100%

$50

1.0

diagnostic a

100%

$50

1.0

medication b

inpatient

100%

$3000

1.0

hospitalization

 

100%

$50

2.0

physician a

100%

$50

1.0

diagnostic a

100%

$50

1.0

medication b

Bronchiolitis/pneumonia

 

outpatient only

100%

$50

2.0

physician a

 

100%

$50

1.0

diagnostic a

100%

$50

1.0

medication b

Bronchiolitis/pneumonia

 

inpatient

100%

$4000

1.0

hospitalization

 

100%

$50

2.0

physician a

100%

$50

1.0

diagnostic a

100%

$50

1.0

medication b

AGE 2–64

 

Upper Respiratory

 

pharyngitis, otitis media

50%

$50

1.0

physician a

 

50%

$50

1.0

diagnostic a

50%

$50

1.0

medication b

Bronchiolitis/pneumonia

 

outpatient only

50%

$50

2.0

physician a

 

50%

$50

1.0

diagnostic a

50%

$50

1.0

medication b

AGE 65+

 

Upper Respiratory

 

pharyngitis, otitis media

50%

$50

1.0

physician a

 

50%

$50

1.0

diagnostic a

50%

$50

1.0

medication b

Bronchiolitis/pneumonia

 

outpatient only

50%

$50

2.0

physician a

 

50%

$50

1.0

diagnostic a

50%

$50

1.0

medication b

Bronchiolitis/pneumonia

 

inpatient

100%

$4000

1.0

hospitalization

 

100%

$50

2.0

physician a

100%

$50

1.0

diagnostic a

100%

$50

1.0

medication b

Suggested Citation:"Appendix 19: Parainfluenza Virus." Institute of Medicine. 2000. Vaccines for the 21st Century: A Tool for Decisionmaking. Washington, DC: The National Academies Press. doi: 10.17226/5501.
×

VACCINE DEVELOPMENT

The committee assumed that it will take 7 years until licensure of a PIV vaccine and that $300 million needs to be invested for licensure for infants and another $360 million for a vaccine for pregnant women. Table 4–1 summarizes vaccine development assumptions for all vaccines considered in this report.

VACCINE PROGRAM CONSIDERATIONS

Target Population

For the purposes of the calculations in this report, it is assumed that the target population for this vaccine is all infants and all primiparas. It was assumed that 90% of infants and targeted pregnant women would receive the vaccine.

Vaccine Schedule, Efficacy, and Costs

For the purposes of the calculations in this report, it was estimated that this vaccine would cost $50 per dose and that administration costs would be $10 per dose. Default assumptions of a 3-dose series and 75% effectiveness were accepted. Table 4–1 summarizes vaccine program assumptions for all vaccines considered in this report.

RESULTS

If a vaccine program for PIV were implemented today and the vaccine were 100% efficacious and utilized by 100% of the target population, the annualized present value of the QALYs gained would be 21,000. Using committee assumptions of less-than-ideal efficacy and utilization and including time and monetary costs until a vaccine program is implemented, the annualized present value of the QALYs gained would be 10,000.

If a vaccine program for PIV were implemented today and the vaccine was 100% efficacious and utilized by 100% of the target population, the annualized present value of the health care costs saved would be $580 million. Using committee assumptions of less-than-ideal efficacy and utilization and including time and monetary costs until a vaccine program is implemented, the annualized present value of the health care costs saved would be $275 million.

If a vaccine program for PIV were implemented today and the vaccine was 100% efficacious and utilized by 100% of the target population, the annualized present value of the program cost would be $1 billion. Using committee assumptions of less-than-ideal efficacy and utilization and including time and

Suggested Citation:"Appendix 19: Parainfluenza Virus." Institute of Medicine. 2000. Vaccines for the 21st Century: A Tool for Decisionmaking. Washington, DC: The National Academies Press. doi: 10.17226/5501.
×

monetary costs until a vaccine program is implemented, the annualized present value of the program cost would be $640 million.

Using committee assumptions of time and costs until licensure, the fixed cost of vaccine development has been amortized and is $19.8 million for a PIV vaccine.

If a vaccine program were implemented today and the vaccine was 100% efficacious and utilized by 100% of the target population, the annualized present value of the cost per QALY gained is $20,000. Using committee assumptions of less-than-ideal utilization and including time and monetary costs until a vaccine program is implemented, the annualized present value of the cost per QALY gained is $38,000. If only 10% of primiparas utilized the vaccine, the annualized present value of the cost per QALY gained is $50,000.

See Chapters 4 and 5 for details on the methods and assumptions used by the committee for the results reported.

READING LIST

Hall CB. Parainfluenza Viruses. In: Textbook of Pediatric Infectious Diseases. RD Feigin and JD Cherry eds. Philadelphia, PA: WB Saunder Company, 1992, pp. 1613–1624.

Henrickson K, Ray R, Belshe R. Parainfluenza Viruses. In: Principles and Practice of Infectious Diseases. GL Mandell, JE Bennett, Dolin R eds. New York, NY: Churchill Livingstone, 1995, pp. 1489–1496.


Karron RA, Wright PF, Newman FK, et al. A Live Human Parainfluenza Type 3 Virus Vaccine is Attenuated and Immunogenic in Healthy Infants and Children. The Journal of Infectious Diseases 1995; 172:1445–1450.


Ventura SJ, Martin JA, Mathews TJ, et al. Advance Report of Final Natality Statistics, 1994. Monthly Vital Statistics Report 1996; 44.

Suggested Citation:"Appendix 19: Parainfluenza Virus." Institute of Medicine. 2000. Vaccines for the 21st Century: A Tool for Decisionmaking. Washington, DC: The National Academies Press. doi: 10.17226/5501.
×
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Suggested Citation:"Appendix 19: Parainfluenza Virus." Institute of Medicine. 2000. Vaccines for the 21st Century: A Tool for Decisionmaking. Washington, DC: The National Academies Press. doi: 10.17226/5501.
×
Page 273
Suggested Citation:"Appendix 19: Parainfluenza Virus." Institute of Medicine. 2000. Vaccines for the 21st Century: A Tool for Decisionmaking. Washington, DC: The National Academies Press. doi: 10.17226/5501.
×
Page 274
Suggested Citation:"Appendix 19: Parainfluenza Virus." Institute of Medicine. 2000. Vaccines for the 21st Century: A Tool for Decisionmaking. Washington, DC: The National Academies Press. doi: 10.17226/5501.
×
Page 275
Suggested Citation:"Appendix 19: Parainfluenza Virus." Institute of Medicine. 2000. Vaccines for the 21st Century: A Tool for Decisionmaking. Washington, DC: The National Academies Press. doi: 10.17226/5501.
×
Page 276
Suggested Citation:"Appendix 19: Parainfluenza Virus." Institute of Medicine. 2000. Vaccines for the 21st Century: A Tool for Decisionmaking. Washington, DC: The National Academies Press. doi: 10.17226/5501.
×
Page 277
Suggested Citation:"Appendix 19: Parainfluenza Virus." Institute of Medicine. 2000. Vaccines for the 21st Century: A Tool for Decisionmaking. Washington, DC: The National Academies Press. doi: 10.17226/5501.
×
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Vaccines have made it possible to eradicate the scourge of smallpox, promise the same for polio, and have profoundly reduced the threat posed by other diseases such as whooping cough, measles, and meningitis.

What is next? There are many pathogens, autoimmune diseases, and cancers that may be promising targets for vaccine research and development.

This volume provides an analytic framework and quantitative model for evaluating disease conditions that can be applied by those setting priorities for vaccine development over the coming decades. The committee describes an approach for comparing potential new vaccines based on their impact on morbidity and mortality and on the costs of both health care and vaccine development. The book examines:

  • Lessons to be learned from the polio experience.
  • Scientific advances that set the stage for new vaccines.
  • Factors that affect how vaccines are used in the population.
  • Value judgments and ethical questions raised by comparison of health needs and benefits.

The committee provides a way to compare different forms of illness and set vaccine priorities without assigning a monetary value to lives. Their recommendations will be important to anyone involved in science policy and public health planning: policymakers, regulators, health care providers, vaccine manufacturers, and researchers.

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