Cost-effectiveness analysis of pneumococcal conjugate vaccines in preventing pneumonia in Peruvian children

Abstract

Introduction: Pneumococcal pneumonia (PP) has a high burden of morbimortality in children. Use of pneumococcal conjugate vaccines (PCVs) is an effective preventive measure. After PCV 7-valent (PCV7) withdrawal, PCV 10-valent (PCV10) and PCV 13-valent (PCV13) are the alternatives in Peru. This study aimed to evaluate cost effectiveness of these vaccines in preventing PP in Peruvian children <5 yearsold. Methodology: A cost-effectiveness analysis was developed in three phases: a systematic evidence search for calculating effectiveness; a cost analysis for vaccine strategies and outcome management; and an economic model based on decision tree analysis, including deterministic and probabilistic sensitivity analysis using acceptability curves, tornado diagram, and Monte Carlo simulation. A hypothetic 100 vaccinated children/vaccine cohort was built. An incremental cost-effectiveness ratio (ICER) was calculated. Results: The isolation probability for all serotypes in each vaccine was estimated: 38% for PCV7, 41% PCV10, and 17% PCV13. Avoided hospitalization was found to be the best effectiveness model measure. Estimated costs for PCV7, PCV10, and PCV13 cohorts were USD13,761, 11,895, and 12,499, respectively. Costs per avoided hospitalization were USD718 for PCV7, USD333 for PCV10, andUSD 162 for PCV13. At ICER, PCV7 was dominated by the other PCVs. Eliminating PCV7, PCV13 was more cost effective than PCV10 (confirmed in sensitivity analysis). Conclusions: PCV10 and PCV13 are more cost effective than PCV7 in prevention of pneumonia in children <5 years-old in Peru. PCV13 prevents more hospitalizations and is more cost-effective than PCV10. These results should be considered when making decisions about the Peruvian National Inmunizations Schedule.

Cost-effectiveness analysis of a universal mass vaccination program with a PHiD-CV 2+1 schedule in Malaysia

“…This dominance is in line with various other cost-effectiveness analyses, from Malaysia [ 10 ], Japan [ 57 ], the Philippines [ 27 ], Turkey [ 58 ], Europe [ 20 , 59 – 61 ], Canada [ 20 ] and Peru [ 53 ]. However, some studies have predicted the reverse: that PCV13 would be dominant over PHiD-CV (Malaysia and Hong Kong [ 11 ], Colombia [ 62 ], Europe [ 63 ] and Canada [ 64 ]) or more cost-effective than PHiD-CV (Peru [ 65 ]). These differences in predicted outcomes are largely due to the assumptions used.…”

Cost-effectiveness analysis of 10- and 13-valent pneumococcal conjugate vaccines in Peru

“…b All pneumococcal sepsis refer to non-pneumonia non-meningitis invasive disease (NPNM). [31]. Also contrasting our findings, GlaxoSmithKline ® (GSK) performed a cost-utility analysis on PCV introduction in Peru whose results suggested that PCV10 was more cost-effective than PCV13 [68].…”

“…The approved National Immunization Schedule for PCV7 in Peru included two primary doses at 2 and 4 months of age, plus a booster at 12-18 months (PCV2 + 1) [4,31,32]. Vaccination coverage was assumed based on coverage levels achieved with PCV7 for 2011, which were 99.2% for the first dose, 95.8% for the second and 92.5% for the booster.…”

Uso de la evidencia en politicas y programas de salud aportes del Instituto Nacional de Salud

“…En respuesta a esta necesidad de evidencia del MINSA el INS realizó dos evaluaciones económicas. El primer estudio demostró que la vacuna VCP13 es más costo efectiva que la VCP10 para prevenir neumonía en niños menores de cinco años en Perú (18,19) . El segundo estudio extendió el análisis a otras afecciones: otitis media y meningitis encontrando similares resultados (20,21) .…”