Retrospective Impact Analysis and Cost-Effectiveness of the Pneumococcal Conjugate Vaccine Infant Program in Australia

Abstract

Australia introduced the 7-valent pneumococcal conjugate vaccine (7vPCV) on the universal infant National Immunisation Program (NIP) in 2005 and replaced it with the 13-valent pneumococcal conjugate vaccine (13vPCV) in 2011, both under a 3 ? 0 schedule. The objective of this analysis was to quantify the clinical and economic impact of the universal infant PCV program in Australia from its introduction. A decision-analytic model was developed to estimate the historical impact of pneumococcal conjugate vaccine (PCV) programs in Australia from a direct health care perspective. Historical incidence of invasive pneumococcal disease (IPD), pneumonia, and otitis media (OM) were obtained from available Australian epidemiologic databases supplemented with published data. Costs were from Medicare Benefits Schedule in 2018 Australian dollars and utility weights from published sources. Historical observed changes in disease for the universal PCV NIP era (2005-2017) were compared against a ''no-vaccine'' scenario. The expected incidence for the no-vaccine scenario in years 2005-2017 was calculated using pre-universal PCV NIP era (2001-2004) data. Averted cases, deaths, incremental costs, and quality-adjusted life years (QALYs) were obtained by subtracting the vaccine scenario totals from the no-vaccine scenario totals. From the inclusion in the universal infant NIP, 7vPCV and 13vPCV are estimated to have prevented 1,770,024 cases of pneumococcal disease (IPD = 16,392; OM = 1,575,491; pneumonia = 102,059) and 1195 associated deaths. Over this period, there was a total 24,335 QALYs gained. Costs for the universal infant NIP were offset by $733 million direct costs saved, resulting in an incremental cost-effectiveness ratio of $3347 per QALY gained. PCVs have provided substantial public health and economic value from sustained use in Australia. Results are conservative, since long-term pneumococcal disease consequences and broader socioeconomic benefits were not considered. Maintaining 13vPCV on the Australian infant NIP under the newly implemented 2 ? 1 schedule will likely provide more return on investment and sustained reductions in pneumococcal disease.

Impact of pneumococcal conjugate vaccines on healthcare utilization and direct costs for otitis media in children ≤2 years of age in two Swedish regions

“…The results of our study were consistent across the two regions and are consistent with trends observed in a real-world analysis conducted in Australia. 29 Confirmation of the effectiveness of vaccination programs is necessary to maintain confidence among policymakers, clinicians, and the general public. Our study provides real-world confirmation of the benefit of higher-valency PCVs.…”

Clinical and Economic Burden of Pneumococcal Disease Due to Serotypes Contained in Current and Investigational Pneumococcal Conjugate Vaccines in Children Under Five Years of Age

“…Australia had the highest remaining burden of PCV13 serotypes among PCV13 NIPs, which may be due to the prior use of the 3 + 0 schedule compared to other countries which utilize a booster dose in either a 2 + 1 or 3 + 1 schedule. As of July 2018, Australia has made the decision to move to a 2 + 1 schedule, thus serotype distributions may change in future years [ 52 ].…”

“…This proportion ranged from 20–53% for inpatient and outpatient PNE and 20–38% for OM among included countries. For countries where no data were available, we conservatively assumed that 20% of both all-cause PNE and OM disease were attributable to S. pneumoniae [ 46 , 51 , 52 ]. Furthermore, given that the etiology is not known, the serotypes causing non-IPD are also uncertain.…”

“…Furthermore, given that the etiology is not known, the serotypes causing non-IPD are also uncertain. Therefore, we assumed that the serotype distribution causing non-IPD disease was equivalent to IPD, consistent with previous economic burden and cost-effectiveness evaluations [ 46 , 52 , 53 ].…”

Reply letter to “response to article by Johnna Perdrizet et al.” by Gomez and colleagues

“…The cost-effectiveness model used for this Brazil study uses the same assumptions as many other peer-reviewed studies, including country examples for Mexico, Colombia, Finland, Netherlands, Canada, Malaysia, Italy, and Australia. [5][6][7][8][9][10] This scientific methodology used for pneumococcal disease serotype trends has been recognized and is a strength of this study because we were able to show with numerous predictions from multiple countries the possible range of outcomes when switching to PCV13. These trendlines serve as a proxy for what Brazil can expect for a PCV13 NIP infant program and ultimately capture variations in uptake, antimicrobial resistance, underlying serotype dynamics, indirect effect, and historical schedules observed in other countries.…”