Cost-effectiveness of 13-valent pneumococcal conjugate vaccination in Mongolia

Abstract

ObjectiveThe Ministry of Health (MOH), Mongolia, is considering introducing 13-valent pneumococcal conjugate vaccine (PCV13) in its national immunization programme to prevent the burden of disease caused by Streptococcus pneumoniae. This study evaluates the cost-effectiveness and budget impact of introducing PCV13 compared to no PCV vaccination in Mongolia.MethodsThe incremental cost-effectiveness ratio (ICER) of introducing PCV13 compared to no PCV vaccination was assessed using an age-stratified static multiple cohort model. The risk of various clinical presentations of pneumococcal disease (meningitis, pneumonia, non-meningitis non-pneumonia invasive pneumococcal disease and acute otitis media) at all ages for thirty birth cohorts was assessed. The analysis considered both health system and societal perspectives. A 3 + 0 vaccine schedule and price of US$3.30 per dose was assumed for the baseline scenario based on Gavi, the Vaccine Alliance’s advance market commitment tail price.ResultsThe ICER of PCV13 introduction is estimated at US$52 per disability-adjusted life year (DALY) averted (health system perspective), and cost-saving (societal perspective). Although indirect effects of PCV have been well-documented, a conservative scenario that does not consider indirect effects estimated PCV13 introduction to cost US$79 per DALY averted (health system perspective), and US$19 per DALY averted (societal perspective). Vaccination with PCV13 is expected to cost around US$920,000 in 2016, and thereafter US$820,000 every year. The programme is likely to reduce direct disease-related costs to MOH by US$440,000 in the first year, increasing to US$510,000 by 2025.ConclusionIntroducing PCV13 as part of Mongolia’s national programme appears to be highly cost-effective when compared to no vaccination and cost-saving from a societal perspective at vaccine purchase prices offered through Gavi. Notwithstanding uncertainties around some parameters, cost-effectiveness of PCV introduction for Mongolia remains robust over a range of conservative scenarios. Availability of high-quality national data would improve future economic analyses for vaccine introduction.

Microbiological and Susceptibility Profile of Clinical Gram Positive Isolates at a Tertiary Pediatric and Maternity Hospital in Ulaanbaatar, Mongolia

“…Pneumococcal vaccination of infants has recently been introduced to targeted populations in Mongolia but is not universal yet 28 . In the coming years, more widespread pneumococcal vaccination is likely to change the epidemiology of pneumococcal infections in Mongolia.…”

Pneumococcal Vaccination for Children in Asian Countries: A Systematic Review of Economic Evaluation Studies

“…Seven studies assessed the cost-effectiveness of PCV-7 [27,29,30,32,33,39,46], of which one study assessed its effectiveness in the context of typical and pandemic influenza seasons [30]. PCV-13 was assessed in six studies [35,38,40,41,43,45] and comparisons of various types of vaccines were performed in two studies [26,48]. The majority of studies used quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs) as the health outcomes measure [20,25,26,32,[35][36][37][38][39][40][41]44,47,48] while the rest combined both the clinical and the utility outcomes or provided only clinical outcomes, e.g., cases of pneumococcal-related diseases and life years.…”

“…The included studies were conducted in 11 Asian countries, including China (n = 7) [26,30,32,33,35,41,48] Malaysia (n = 3) [34,42,44], Hong Kong (n = 3) [28,29,42] Korea (n = 2) [25,46], The Philippines (n = 2) [31,36],Taiwan (n = 2) [27,43], Japan (n = 3) [20,38,39], Thailand (n = 1) [47], Mongolia (n = 1) [45], Bhutan (n = 1) [37], and India (n = 1) [40] (Table 1). One study was a multiple country analysis, performed in Malaysia and Hong Kong [42].…”

“…The oldest study that appeared from our search was from 2009, addressing the CEA of PCV-7 in Hong Kong [29], and the most recent one was from 2019, investigating the cost-effectiveness of PCV-13 in India [40]. At the time when the research was conducted, only three countries, i.e., Mongolia, Bhutan, and India [37,40,45], were eligible for discounted vaccine purchase prices offered through support from Gavi, The Vaccine Alliance, an organization established in 2000 to improve access to the vaccine for children in the world's poorest countries [49].…”

Towards the introduction of pneumococcal conjugate vaccines in Bhutan: A cost-utility analysis to determine the optimal policy option

“…Until now there have been at least 20 economic evaluation studies conducted in Asia [6] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] . However, this is the first study conducted in South Asia.…”