Indirect costs of adult pneumococcal disease and the productivity-based rate of return to the 13-valent pneumococcal conjugate vaccine for adults in Turkey

Abstract

Productivity benefits of health technologies are ignored in typical economic evaluations from a health payer's perspective, risking undervaluation. We conduct a productivity-based cost-benefit analysis from a societal perspective and estimate indirect costs of adult pneumococcal disease, vaccination benefits from the adult 13-valent pneumococcal conjugate vaccine (PCV13 Adult), and rates of return to PCV13 Adult for a range of hypothetical vaccination costs. Our context is Turkey's funding PCV13 for the elderly and for non-elderly adults with select comorbidities within the Ministry of Health's National Immunization Program. We use a Markov model with one-year cycles. Indirect costs from death or disability equal the expected present discounted value of lifetime losses in the infected individual's paid and unpaid work and in caregivers' paid work. Vaccination benefits comprise averted indirect costs. Rates of return equal vaccination benefits divided by vaccination costs, minus one. Input parameters are from public data sources. We model comorbidities' effects by scalar multiplication of the parameters of the general population. Indirect costs per treatment episode of inpatient community-acquired pneumonia (CAP), bacteremia, and meningitisbut not for outpatient CAPapproach or exceed Turkish per capita gross domestic product. Vaccination benefits equal $207.02 per vaccination in 2017 US dollars. The rate of return is positive for all hypothetical costs below this. Results are sensitive to herd effects from pediatric vaccination and vaccine efficacy rates. For a wide range of hypothetical vaccination costs, the rate of return compares favorably with those of other global development interventions with well-established strong investment cases.

Pneumococcal and Influenza Vaccination Rates and Pneumococcal Invasive Disease Rates Set Geographical and Ethnic Population Susceptibility to Serious COVID-19 Cases and Deaths

“…Adult and at-risk pneumococcal and influenza vaccination data were obtained from [ 5 ] and: Andorra [ 108 ]; Argentina [ 109 , 110 ]; Belgium [ 111 ]; Brazil [ 112 ]; Central and Eastern Europe [ 113 ]; Denmark [ 114 , 115 ]; European nations [ 85 , 116 , 117 , 118 , 119 ]; Europe and Gulf nations [ 120 ]; Germany [ 121 ]; Gulf nations [ 122 , 123 ]; Hong Kong [ 124 ]; Hungary [ 125 ]; Iceland [ 126 ]; Ireland [ 127 ]; Israel [ 128 ]; Latin America [ 129 ]; Mexico [ 130 , 131 ]; New Zealand [ 132 ]; Poland [ 133 ]; Qatar [ 134 ]; San Marino [ 135 ]; Singapore [ 136 ]; Slovenia [ 137 ]; South Africa [ 138 ]; Sweden [ 139 ]; Switzerland [ 140 , 141 , 142 ]; Taiwan [ 143 , 144 , 145 ]; Turkey [ 146 , 147 , 148 ]; and U.K. [ 149 ]. All of these data are summarized in Table 1 .…”

Economic Evaluation of Vaccines: Belgian Reflections on the Need for a Broader Perspective

“…60 Such a rate of return exceeds the rate of return of other global development interventions commonly accepted to have a strong investment case, such as primary schooling. 60,61 In an Italian study focusing on the vaccination of infants with a quadrivalent vaccine against serogroup B meningococcal disease, cost-effectiveness improved from V37 827 to V26 599 per QALY gained when costs of special education for patients and costs of decreased parent productivity were considered. 62 The effect of infectious diseases on productivity extends to individuals taking care of patients, as is the case with other disabling chronic and noncommunicable diseases.…”