Cost Effectiveness of the 13-Valent Pneumococcal Conjugate Vaccination Program in Chronic Obstructive Pulmonary Disease Patients Aged 50+ Years in Spain

Abstract

BackgroundPatients with chronic obstructive pulmonary disease (COPD) are at elevated risk of pneumococcal infection. A 13-valent pneumococcal conjugate vaccine (PCV13) was approved for protection against invasive disease and pneumonia caused by Streptococcus pneumoniae in adults. This study estimated the incremental cost-effectiveness ratio (ICER) of vaccinating COPD patients ≥50 years old with PCV13 compared with current vaccination policy (CVP) with 23-valent pneumococcal polysaccharide vaccine.MethodsA Markov model accounting for the risks and costs for all-cause non-bacteremic pneumonia (NBP) and invasive pneumococcal disease (IPD) was developed. All parameters, such as disease incidence and costs (€; 2015 values), were based on published data. The perspective of the analysis was that of the Spanish National Healthcare System, and the horizon of evaluation was lifetime in the base case. Vaccine effectiveness considered waning effect over time. Outcomes and costs were both discounted by 3 % annually.ResultsOver a lifetime horizon and for a 629,747 COPD total population, PCV13 would prevent 2224 cases of inpatient NBP, 3134 cases of outpatient NBP, and 210 IPD extra cases in comparison with CVP. Additionally, 398 related deaths would be averted. The ICER was €1518 per quality-adjusted life-year (QALY) gained for PCV13 versus CVP. PCV13 was found to be cost effective versus CVP from a 5-year modelling horizon (1302 inpatient NBP and 1835 outpatient NBP cases together with 182 deaths would be prevented [ICER €25,573/QALY]). Univariate and probabilistic sensitivity analyses confirmed the robustness of the model.ConclusionsAt the commonly accepted willingness-to-pay threshold of €30,000/QALY gained, PCV13 vaccination in COPD patients aged ≥50 years was a cost-effective strategy compared with CVP from 5 years to lifetime horizon in Spain.

Avaliação de custo-efetividade da vacina pneumocócica conjugada 13-valente comparada à vacina pneumocócica polissacarídica e não vacinação no Sistema de Saúde Suplementar Brasileiro

“…Estudos desenvolvidos na Holanda (Mangen et al, 2015) e na Espanha (Rodríguez González-Moro et al, 2016) mostraram eficiência de PCV13 versus a política vigente de vacinação naqueles países para diversos subgrupos populacionais, incluindo aqueles com doença pulmonar obstrutiva crônica (Rodríguez González-Moro et al, 2016).…”

The cost-effectiveness of using pneumococcal conjugate vaccine (PCV13) versus pneumococcal polysaccharide vaccine (PPSV23), in South African adults

“…• For incidence rates, vaccine effectiveness and case-fatality rates, a beta distribution was used, with the number of cases and non-cases in the cohort as inputs. This is relevant as the value of these parameters are probabilities ranging between 0 and 1 [66,67].…”

“…• For indirect effects and utility values, a uniform distribution was used, with the minimum and maximum value of these parameters as inputs [66]. • For costs, a log-normal distribution was used, with the mean cost per case and the standard error of the cost per case as inputs.…”

Cost-effectiveness of introducing the pneumococcal conjugate vaccine for children under 5 years in the Islamic Republic of Iran

“…acute otitis media) to invasive pneumococcal diseases (e.g. meningitis and bacteraemia) that can be life-threatening (2)(3)(4)(5). Invasive pneumococcal diseases kill over 500 000 children under 5 years old each year (6), and accounted for nearly 9% of deaths in children aged 1-59 months in 2008 in South America (7).…”

“…The main advantage of a childhood vaccination programme against S. pneumoniae is that it saves lives by preventing S. pneumoniae infection and hence the adverse complications of pneumococcal diseases, and this counterbalances the costs of the programme (5). Vaccination of children under 5 years would also indirectly reduce the incidence of invasive pneumococcal diseases by reducing the rate of nasopharyngeal carriers of S. pneumoniae (10)(11)(12).…”