Cost-utility analysis of 10- and 13-valent pneumococcal conjugate vaccines: Protection at what price in the Thai context?

Kulpeng, Wantanee; Leelahavarong, Pattara; Rattanavipapong, Waranya; Sornsrivichai, Vorasith; Baggett, Henry C.; Meeyai, Aronrag; Punpanich, Warunee; Teerawattananon, Yot

doi:10.1016/j.vaccine.2013.03.047

Cited by 52 publications

(57 citation statements)

References 32 publications

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“…However, the Thailand study showed that at current prices, PCV10 and PCV13 are not cost-effective even with the inclusion of vaccine herd effects. 19 However, there have been similarities of 3 studies in that all have utilized state-transition Markov model, and applied country-specific serotype data to adjust for vaccine effectiveness on vaccinated and unvaccinated populations. Contrary to our study results, a prior study in Malaysia concluded that a PCV10 program was cost-effective compared with PCV13.…”

Section: Discussionmentioning

confidence: 99%

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

Roberts

Lee

et al. 2015

Human Vaccines & Immunotherapeutics

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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.

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Section: Discussionmentioning

confidence: 99%

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

Roberts

Lee

et al. 2015

Human Vaccines & Immunotherapeutics

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“…A Markov model with one-year cycle length adapted from a prior study [14] was used to estimate the lifetime costs and outcomes for PCV10 and PCV13 compared to 'no vaccination', consisting of three major health states: good health, S. pneumoniae infection and death (Fig 1). Whilst the model structure for this study was adapted from Thai setting, this model has been validated in consultation meetings by Philippine experts including infectious disease specialists, epidemiologists, health economists, and policy decision makers.…”

Section: Markov Modelmentioning

confidence: 99%

“…For PCV13, demonstration of VE is based on non-inferior immunogenicity compared with PCV7 rather than efficacy trials measuring clinical endpoints [28,29]. However, evidence supporting the effectiveness of PCV13 for covered serotypes has been documented in various [14] (Continued)…”

Section: Model Input Parametersmentioning

confidence: 99%

“…Due to a lack of local studies and considering that the number of claims for relatively rare sequelaes due to S. pneumoniae may not be representative of the total number of cases in the country, the cost per year of these conditions were obtained from Thai cost data as presented in the economic evaluation of PCV 10 and 13 in Thai context [14]. 2010 Thai figures and 2012 PhilHealth figures were adjusted to 2013 for inflation and PPP (1 THB = 1.54 PHP), using the EPPI Centre Cost Converter as of 27 January 2014 [46].…”

Section: Model Input Parametersmentioning

confidence: 99%

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Do pneumococcal conjugate vaccines represent good value for money in a lower-middle income country? A cost-utility analysis in the philippines

et al. 2015

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ObjectivesThe objective of this study is to assess the value for money of introducing pneumococcal conjugate vaccines as part of the immunization program in a lower-middle income country, the Philippines, which is not eligible for GAVI support and lower vaccine prices. It also includes the newest clinical evidence evaluating the efficacy of PCV10, which is lacking in other previous studies. MethodsA cost-utility analysis was conducted. A Markov simulation model was constructed to examine the costs and consequences of PCV10 and PCV13 against the current scenario of no PCV vaccination for a lifetime horizon. A health system perspective was employed to explore different funding schemes, which include universal or partial vaccination coverage subsidized by the government. Results were presented as incremental cost-effectiveness ratios (ICERs) in Philippine peso (Php) per QALY gained (1 USD = 44.20 Php). Probabilistic sensitivity analysis was performed to determine the impact of parameter uncertainty. ResultsWith universal vaccination at a cost per dose of Php 624 for PCV10 and Php 700 for PCV13, both PCVs are cost-effective compared to no vaccination given the ceiling threshold of Php 120,000 per QALY gained, yielding ICERs of Php 68,182 and Php 54,510 for PCV10 and PCV13, respectively. Partial vaccination of 25% of the birth cohort resulted in significantly higher ICER values (Php 112,640 for PCV10 and Php 84,654 for PCV13) due to loss of herd protection. The budget impact analysis reveals that universal vaccination PLOS ONE |

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“…The remaining four LLMIC studies used arbitrary thresholds or compared against interventions that were already implemented. Two of the three UMIC studies that used another threshold were set in Thailand and used Thailand's national threshold of GNI per QALY gained (Kulpeng et al , , Rattanavipapong et al , ).…”

Section: Resultsmentioning

confidence: 99%

Comparison of Economic Evaluation Methods Across Low‐income, Middle‐income and High‐income Countries: What are the Differences and Why?

2016

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There are marked differences in methods used for undertaking economic evaluations across low‐income, middle‐income, and high‐income countries. We outline the most apparent dissimilarities and reflect on their underlying reasons. We randomly sampled 50 studies from each of three country income groups from a comprehensive database of 2844 economic evaluations published between January 2012 and May 2014. Data were extracted on ten methodological areas: (i) availability of guidelines; (ii) research questions; (iii) perspective; (iv) cost data collection methods; (v) cost data analysis; (vi) outcome measures; (vii) modelling techniques; (viii) cost‐effectiveness thresholds; (ix) uncertainty analysis; and (x) applicability. Comparisons were made across income groups and odds ratios calculated. Contextual heterogeneity rightly drives some of the differences identified. Other differences appear less warranted and may be attributed to variation in government health sector capacity, in health economics research capacity and in expectations of funders, journals and peer reviewers. By highlighting these differences, we seek to start a debate about the underlying reasons why they have occurred and to what extent the differences are conducive for methodological advancements. We suggest a number of specific areas in which researchers working in countries of differing environments could learn from one another. © 2016 The Authors. Health Economics published by John Wiley & Sons Ltd.

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Cost-utility analysis of 10- and 13-valent pneumococcal conjugate vaccines: Protection at what price in the Thai context?

Abstract: At current prices, PCV10 and PCV13 are not cost-effective in Thailand. Inclusion of indirect vaccine effects substantially reduced the ICERs for both vaccines, but did not result in cost effectiveness.

Cited by 52 publications

References 32 publications

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

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

Do pneumococcal conjugate vaccines represent good value for money in a lower-middle income country? A cost-utility analysis in the philippines

Comparison of Economic Evaluation Methods Across Low‐income, Middle‐income and High‐income Countries: What are the Differences and Why?

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