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To the Editor: Dr Lieu and colleagues¹ used pneumococcal vaccine efficacy estimates of 7%, 19%, and 20% for the prevention of simple otitis media (OM), complex OM, and OM requiring tympanostomy tube placement, respectively. These estimates are extrapolations of the vaccine efficacy against OM when the vaccine was given to infants in a 4-dose series as conducted in the Northern California Kaiser Permanente trial.² Although the conjugate vaccine is immunogenic in older children, I question the validity of using the same efficacy data to calculate the cost-effectiveness of a single "catch-up" dose in older children.

Cost-effectiveness analyses should also take into consideration assumptions such as the natural history of the disease and the variation in medical practice settings. The decrease in the incidence of OM in older children compared with infants and toddlers, the fact that 80% of cases of OM can improve without antibiotics,³ and new shorter courses of . . . [Full Text of this Article]

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RELATED ARTICLE

Projected Cost-effectiveness of Pneumococcal Conjugate Vaccination of Healthy Infants and Young Children
Tracy A. Lieu, G. Thomas Ray, Steven B. Black, Jay C. Butler, Jerome O. Klein, Robert F. Breiman, Mark A. Miller, and Henry R. Shinefield
JAMA. 2000;283(11):1460-1468.
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