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Thursday, March 03, 2011

Costs of Treating Vaccine-Preventable Diseases

This is a page that I will be adding to the Vaccine Page as soon as I get permission from Todd W, and some more information is filled in.  This is still a work in progress.  I just want to give you all a taste:

Costs of Treating Vaccine-Preventable Diseases


Much is often made of the supposed profits made by pharmaceutical companies from vaccines.  Of course there is some profit from vaccines.  After all, pharmaceuticals are just like any other industry.  Without profit, the companies would either fold or fail to grow.  No profits, no research into how to improve products, to make them more effective or safer.  The pertinent question to ask, then, is whether these vaccines are a sufficient motivation for putting people at risk.  Part of this is another question: what are the profits made by treating the diseases that vaccines prevent?  As of October 2010, there are 15 diseases that are part of the recommended childhood immunization schedule from birth to 18 years.  Additions to this page will be slow.  The research takes a lot of time and this is primarily a side project of mine.  All prices listed are approximate.  Doses listed may differ slightly from what is normally prescribed, due to availability of price listings.  If you would like to help fill out any of the missing elements or can provide corrections (with source information), please contact Todd W..

A brief note before we get started.  The information provided here is for informational use only.  I am not a physician and am not providing this information as medical advice.  If you have serious questions about any of this or are in need of medical attention, please consult your doctor.
Now, let's take a look at the diseases and how they, and their complications, are treated.

Diphtheria

If someone is infected with Corynebacterium diphtheria, the bacterium that causes diphtheria, they will likely need to go to the hospital for treatment using diphtheria antitoxin and antibiotics. The antitoxin cancels out the toxin already circulating in the individual’s body. However, before the antitoxin is administered, it is important to do an allergy test to make sure the patient is not allergic to the antitoxin. If the patient is allergic, then the antitoxin will be administered starting at a very low dose and gradually increasing. It should be noted that the antitoxin is available only from the CDC and only in the U.S. There are very few producers of the antitoxin, and the CDC currently purchases all of its antitoxin from a company in Brazil (PDF link). As with all drugs, diphtheria antitoxin has a range of side effects associated with its use. These range from fever and a chilly sensation to difficulty breathing and swallowing, rash or hives, muscle aches, swelling and sudden, severe tiredness and weakness or serum sickness.

The antibiotics used to treat diphtheria, such as penicillin (4 oral doses per day or 300,000-600,000 units per day intramuscularly for 10 days) or erythromycin (2 IV doses per day or 4 oral doses per day for 14 days), kill the bacteria, reducing the amount of time that the individual is contagious. At the end of two weeks, a culture is taken to make sure that all of the bacteria have been killed. If not, then the course of antibiotics will likely be continued. Antibiotic prophylaxis is also recommended for close contacts. Like the antitoxin, penicillin and erythromycin have their own side effects. These range from the mild and common (e.g., diarrhea, nausea, vomiting) to the more severe and less common (e.g., allergic reaction, bloody stool, persistent diarrhea, seizures, etc.).

In addition to the sore throat and fever that are common with diphtheria, the toxin produced by the bacteria damages tissue in the area of immediate infection, resulting in a thick, gray membrane of dead cells and bacteria to form on the throat and nose. This membrane can obstruct breathing passages, necessitating its removal by a physician.

Should the infection spread via the bloodstream, diphtheria may cause damage to other organs, like the heart. If it damages the heart, it may cause what is called myocarditis, or inflammation of the heart. This can result in relatively minor symptoms, like fever, chest or joint pain or an unusually fast heart rate to more major problems like congestive heart failure and death. Myocarditis is treated with medications like dopamine, epinephrine, digoxin, furosemide, nitroprusside, warfarin, etc.

Diphtheria can also cause damage nerves, causing problems like difficulty swallowing to muscle weakness or paralysis. Potentially, this nerve damage can also cause paralysis of the muscles that control breathing, lead to circulatory collapse or urine retention. If a patient has difficulty breathing, either due to paralysis or obstruction of the breathing passages, intubation (inserting a tube hooked up to a ventilator down the patient’s throat) may be necessary. Peripheral neuropathy from diphtheria may also require pain medication, physical therapy, braces or splints and possibly installation of railings and other safety features to make the home safer for the individual.

It bears mentioning, again, that diphtheria can also result in death, usually due to obstruction of the breathing passages and/or heart failure.

How likely is it for these various complications to occur?
Hospitalization (avg. length of stay: 10 days) – 100% (1 per 1 cases)

Obstructed Airway/Membrane Formation – 42.3% to 50% (1 per 2.4 cases to 1 per 2 cases)

Myocarditis – 10% to 60% (1 per 10 cases to 1 per 1.7 cases)

Nerve Damage – 4.7% to 15% (1 per 21 cases to 1 per 6.7 cases)

Death 5% to 20% (1 per 20 cases to 1 per 5 cases)

How much does treatment cost?
  • Hospitalization (per day):
    • Respiratory Failure...................................................................................$5,200-$5,800
    • Heart Failure w/o complications/comorbitities..........................................$3,800-$5,100
    • Heart Failure w/ CC..................................................................................$3,900-$5,000
    • Heart Failure w/ major CC........................................................................$4,200-$5,500
  • Diphtheria Antitoxin (20K-100K units over 2-4 hrs)........................................$(Researching - Hopefully I'll find it soon)
  • Antibiotics:
    • Penicillin G Benzathine (.6 MU/day for 10 days).......................................$31.40/dose, $314.00 total
    • Erythromycin Base (250mg, 4/day for 14 days).......................................$0.27/pill, $15.12 total
  • Myocarditis:
    • Dopamine (50-100 mcg/min IV)................................................................Price not available
    • Epinephrine (1 mcg/min IV)......................................................................Price not available
    • Digoxin (166mcg, 3/day)..........................................................................$0.35/pill, total dependent on treatment length
    • Furosemide (10-20 mg, 2/day).................................................................$0.27/pill, total dependent on treatment length
    • Nitroprusside (5-10 mg/min IV)................................................................Price not available
    • Warfarin (.5-3.4 mg/day for 2-5 days).....................................................$0.33/pill, up to $1.65 total
  • Peripheral Neuropathy:
    • Mechanical Ventilation..............................................................................See price for Respiratory Failure above
    • Vasopressors (3-10 days)........................................................................Price not available
    • Urethral Catheterization (5-14 days).......................................................Price not available, see Hospitalization above
  • Death (casket, funeral, plot, etc.)..................................................................$6,000 - $10,000 and up
Cost of diphtheria vaccine, including tetanus and pertussis and, at the higher end, IPV and Hep B: $20.00 - $70.00 per dose (private sector).



Pertussis

Should someone become infected with Bordetella pertussis, the bacterium that causes pertussis, or whooping cough, the first line of treatment is antibiotics.  Antibiotics can help to reduce the chances of spreading pertussis, as well as possibly reducing the intensity and duration of symptoms.  Some of these may also prevent certain complications, such as secondary bacterial pneumonia.  The typical antibiotics used are erythromycin (4 doses per day for 14 days), azithromycin (1-2 doses per day for 5 days), clarithromycin (1-2 doses per day for 7 days, though not for infants under 1 month of age) or trimethoprim and sulfamethoxazole (TMP-SMZ) (twice a day for 14 days, though not for infants under 2 months of age).  Of these, erythromycin is one of the least expensive.  All, however, carry their own sets of risks and side effects, from the relatively benign (e.g., itching, nausea, abdominal cramps) to the serious (e.g., yeast infections or severe skin rashes) to the very serious and possibly life-threatening (e.g., allergic reaction or liver damage).  Some of these effects are dose-dependent, meaning they will be worse with larger doses.

If left untreated, pertussis may lead to secondary bacterial pneumonia, or pneumonia caused by another bacterium, different from the original infection.  In addition to all the normal effects of pertussis, pneumonia has its own effects.  These can be high fever to chest pain to poor oxygenation of the blood (cyanosis).  Pneumonia has a number of different treatment options, depending on the type of organism causing it.  Additionally, while most cases can be treated at home, it is recommended that infants under two months of age be hospitalized.

Pertussis may also cause seizures, asthma (potentially requiring daily medical treatment and lifestyle changes to treat or prevent flare-ups, though there is no cure), encephalopathy (which may need long-term care), dehydration (with its own complications), malnutrition (potentially requiring administration of parenteral nutrition), rib fractures and hearing loss.  It must also be mentioned that death is a rare, though real, possibility, as well. 

So, how likely are these complications to occur in infants?
Hospitalization (avg. length of stay: 4-6 days) – 69% (1 per 1.4 cases)

Pneumonia – 11.8% to 13% (1 per 8 cases)

Encephalitis – 5% (1 in 20 cases)
Seizures – 1.4% (1 per 71cases)

Encephalopathy – 0.2% (1 per 500 cases)

Death - .07% to .2% (1 per 1,500 cases to 1 per 500 cases)
How much does all of this cost (PDF link), though? 
  • Hospitalization (per day, for pneumonia and pleurisy):
    • Without complications or comorbidities (CC)............................................$3,000 - $4,500
    • With CC....................................................................................................$3,600 - $4,800
    • With major CC..........................................................................................$4,300 - $5,500
  • Antibiotics:
    • Azithromycin (100mg, 1/day for 5 days)...................................................$1.12/pill, $5.60 total
    • Clarithromycin (250mg, 1/day for 7 days).................................................$1.03/pill, $7.21 total
    • Erythromycin Base (250mg, 4/day for 14 days)........................................$0.27/pill, $15.12 total
    • TMP-SMZ (20mg/100mg, 2/day for 14 days).............................................$0.14/pill, $7.84 total
  • Asthma Meds (corticosteroids for long-term management):
    • Ciclesonide (80 mcg, 2/day).....................................................................$211.68 for 320 doses
    • Beclomethasone (50mcg, 2/day)..............................................................$28.00 - $62.00 for 200 doses
    • Fluticasone (50mcg, 2/day)......................................................................$63.00 for 360 doses
  • Encephalopathy.............................................................................................Price not available
  • Death (casket, funeral, plot, etc.)..................................................................$6,000 - $10,000 and up

Cost of pertussis vaccine, including diphtheria and tetanus and, at the higher end, IPV and Hep B$20.00 - $70.00 per dose (private sector).

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