Assessment of Health Benefits and Cost-Effectiveness of 10-Valent and 13-Valent Pneumococcal Conjugate Vaccination in Kenyan Children

Abstract

BackgroundThe GAVI Alliance supported10-valent pneumococcal conjugate vaccine (PCV10) introduction in Kenya. We estimated the cost-effectiveness of introducing either PCV10 or the13-valent vaccine (PCV13) from a societal perspective and explored the incremental impact of including indirect vaccine effects.MethodsThe costs and effects of pneumococcal vaccination among infants born in Kenya in 2010 were assessed using a decision analytic model comparing PCV10 or PCV13, in turn, with no vaccination. Direct vaccine effects were estimated as a reduction in the incidence of pneumococcal meningitis, sepsis, bacteraemic pneumonia and non-bacteraemic pneumonia. Pneumococcal disease incidence was extrapolated from a population-based hospital surveillance system in Kilifi and adjustments were made for variable access to care across Kenya. We used vaccine efficacy estimates from a trial in The Gambia and accounted for serotype distribution in Kilifi. We estimated indirect vaccine protection and serotype replacement by extrapolating from the USA. Multivariable sensitivity analysis was conducted using Monte Carlo simulation. We assumed a vaccine price of US$ 3.50 per dose.FindingsThe annual cost of delivering PCV10 was approximately US$14 million. We projected a 42.7% reduction in pneumococcal disease episodes leading to a US$1.97 million reduction in treatment costs and a 6.1% reduction in childhood mortality annually. In the base case analysis, costs per discounted DALY and per death averted by PCV10, amounted to US$ 59 (95% CI 26–103) and US$ 1,958 (95% CI 866–3,425), respectively. PCV13 introduction improved the cost-effectiveness ratios by approximately 20% and inclusion of indirect effects improved cost-effectiveness ratios by 43–56%. The break-even prices for introduction of PCV10 and PCV13 are US$ 0.41 and 0.51, respectively.ConclusionsIntroducing either PCV10 or PCV13 in Kenya is highly cost-effective from a societal perspective. Indirect effects, if they occur, would significantly improve the cost-effectiveness.

Mortality after Inpatient Treatment for Severe Pneumonia in Children: a Cohort Study

“…The study was conducted at Kilifi County Hospital (KCH) in a rural area on the Kenyan coast. Haemophilus influenzae type b and pneumococcal conjugate vaccines were introduced in November 2001 and February 2011, respectively . The antenatal HIV prevalence is 4.9% .…”

“…Haemophilus influenzae type b and pneumococcal conjugate vaccines were introduced in November 2001 and February 2011, respectively. 15,16 The antenatal HIV prevalence is 4.9%. 17 KCH provides inpatient and outpatient services for HIV and malnutrition.…”

New pneumococcal conjugate vaccine introductions in four sub-Saharan African countries: a cross-country analysis of health systems’ impacts

“…Previous studies either focused on demonstrating the health impact of PCV 4,5,[9][10][11] , or explored how new vaccines affected specific health system functions or vaccination coverage 12,13 . No research has evaluated the effects of adding PCV into EPI nor how it, as one component of the Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea 14 , may have affected wider health systems.…”

“…The Streptococcus pneumoniae bacterium is a major cause of pneumonia 2 , and of other illnesses such as meningitis 3 . The effectiveness of pneumococcal conjugate vaccines (PCV) in preventing pneumonia has been established 4,5 and the World Health Organization recommends the adoption of PCV into vaccination programmes in developing countries with high pneumonia mortality rates 6 . With Gavi Alliance…”

Usefulness of Cost Effectiveness: Evidence versus Applicability

“…Allegedly, one of the reasons that a Secretary of Health in our country was summarily dismissed from Office was his controversial decision to procure Pneumonia Conjugate Vaccine (PCV) 10 over PCV13. Existing CEA studies showed that both PCV 10 and PCV13 were cost effective based on GDP per capita with PCV 13 moderately more cost-effective [3][4][5][6]. During this time, information about the protective effect of Protein D carrier unique to PCV10 against H. influenzae disease has yet to be explored.…”