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A cost-utility analysis of a pneumococcal immunization program was conducted for Quebec. The goal of this study was to estimate the cost, effectiveness and benefit of an immunization program against pneumococcal infection in Quebec. Two strategies were evaluated using the cu rrent situation of infrequent use of 23-valent polysaccharide vaccine as a reference point. The first strategy the 'private ' program was a vaccine promotion program, with no change in the current distribution system. The second strategy the 'public' program consisted of a promotional program combined with free vaccine distribution through the public health care system. The pneumococcal immunization program targeted practically the same clientele as the influenza program , so that in the two scenarios promotional activities and vaccination were linked . A cost-utility analysis was conducted for four target groups: persons living in residential and extended care centres , persons with certain predisposing chronic conditions (primarily diabetes and heart or lung disease) , persons with human immunodeficiency virus (HIV), and person aged 65 years and over who do not fall into any of the other categories. An additional analysis was conducted for all persons aged 65 years and over, with or without a predisposing chronic condition. Assuming that the same number of individuals would be immunized against influenza and pneumococcus , there would be about 100,000 persons to vaccinate each yea r when the program was in its maintenance phase, and about 375,000 persons targeted for catch-up. In the basic scenario, the vaccine was considered of maximum efficacy in preventing invasive infections with bacteremia but less than half as effective in preventing infections without bacteremia, which are twice as common. Sensitivity analyses were conducted on the assumption that the vaccine was totally ineffective in preventing infections without bacteremia or that it was just as effective for both types of infections. The vaccine efficacy rates were taken from the case control study with the most subjects, and reflected reduced efficacy over the course of time and the fact that 10% of strains are not covered by 23-valent vaccine. For persons with HIV, we used efficacy estimates from a group of American experts. In the basic scenario, the total cost of a private program is about $1 million, two-thirds of which is borne by individuals through vaccine purchases and one-third by the public sector (vaccination). The unit cost is $22.80 per dose. If it was decided to revaccinate individuals at risk after six years, the cost would increase by about $1.7 million to a total of$2.7 million per year for the program. In a public program, all costs, a little less than $800,000, are borne by the public sector. The unit cost is $22.1 O per dose. The difference of approximately one-quarter of a million dol -

Pneumococcal Immunization Program: Cost-Utility Analysis for Quebec