Cost-effectiveness analysis of infant universal routine pneumococcal vaccination in Malaysia and Hong Kong

Abstract

Keywords: herd effect, incremental cost-effectiveness ratio (ICER), Markov transition-state model, pneumococcal disease, 13-valent pneumococcal conjugate vaccine (PCV13), 10-valent pneumococcal conjugate vaccine (PCV10)Pneumococcal disease causes large morbidity, mortality and health care utilization and medical and non-medical costs, which can all be reduced by effective infant universal routine immunization programs with pneumococcal conjugate vaccines (PCV). We evaluated the clinical and economic benefits of such programs with either 10-or 13-valent PCVs in Malaysia and Hong Kong by using an age-stratified Markov cohort model with many country-specific inputs. The incremental cost per quality-adjusted life year (QALY) was calculated to compare PCV10 or PCV13 against no vaccination and PCV13 against PCV10 over a 10-year birth cohort's vaccination. Both payer and societal perspectives were used. PCV13 had better public health and economic outcomes than a PCV10 program across all scenarios considered. For example, in the base case scenario in Malaysia, PCV13 would reduce more cases of IPD (C2,296), pneumonia (C705,281), and acute otitis media (C376,967) and save more lives (C6,122) than PCV10. Similarly, in Hong Kong, PCV13 would reduce more cases of IPD cases (C529), pneumonia (C172,185), and acute otitis media (C37,727) and save more lives (C2,688) than PCV10. During the same time horizon, PCV13 would gain over 74,000 and 21,600 additional QALYs than PCV10 in Malaysia and Hong Kong, respectively. PCV13 would be cost saving when compared against similar program with PCV10, under both payer and societal perspective in both countries. PCV13 remained a better choice over PCV10 in multiple sensitivity, scenario, and probabilistic analyses. PCV13s broader serotype coverage in its formulation and herd effect compared against PCV10 were important drivers of differences in outcomes.

Response to Wu et al. — Cost-effectiveness analysis of infant pneumococcal vaccination in Malaysia and Hong Kong

“…have stated that herd-effects from vaccination play a significant role in the cost-effectiveness of pneumococcal conjugate vaccines (PCVs) 1 . This is feasible because pneumococcal vaccination in communities has been consistently followed by significant decreases in both vaccine-type (VT)-carriage and VT-invasive pneumococcal disease (IPD) in unvaccinated groups.…”

“…have also further stated that at the time of publication (submitted on 03 March, 2015; and revised on 19 May, 2015) there were no data to support the indirect impact of PHiD-CV on pneumococcal diseases in adults; 1 this being the premise of their decision to not incorporate any measure of indirect vaccine impact for the vaccine. However, the recent body of published evidence points to the contrary.…”

“…also have claimed that an earlier study on the cost-effectiveness of PHiD-CV compared to PCV13 conducted in Malaysia 12 “ relied on a number of questionable assumptions favoring PCV10 that lacked scientific validation .” 1 The authors pointed to, among others, the assumption of cross-protection for PHiD-CV against serotypes 6A and 19A 1 . However, data to support the assumption of cross-protection for PHiD-CV is presented in a number of robustly designed studies from Brazil, 13 Canada 14 and Finland 8 …”

“…The authors claim that the results of the case-control study in Brazil “ are inconsistent with the national surveillance system in Brazil, which shows an increase in the incidence of serotype 19A invasive pneumococcal disease between 2006 and 2011 in children younger than 5 y[ears] of age .” 1 However, the references 15,16 cited by the authors explain the reason why such a comparison is flawed. Firstly, while a lab-based passive surveillance that captures only a fraction of IPD cases is suitable for evaluating trends in serotype distribution and antibiotic resistance, it is not an ideal system for performing a quantitative assessment of vaccine effectiveness.…”

“…have presented a cost-effectiveness analysis by evaluating the clinical and economic benefits of a routine vaccination program in Malaysia and Hong Kong using the available 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV; Synflorix ™) and 13-valent pneumococcal conjugate vaccine (PCV13; Prevenar 13 ) 1 . While the modeling methodologies are rigorous and sound, many of the assumptions made are inconsistent with the most current published scientific evidence.…”