Cost-effectiveness and cost utility analysis of three pneumococcal conjugate vaccines in children of Peru

Abstract

Background: The clinical and economic burden associated with invasive and non-invasive pneumococcal and non-typeable Haemophilus influenzae (NTHi) diseases is substantial in the Latin America and Caribbean region, where pneumococcal vaccines have only been introduced to a few countries. This study analyzed the cost-effectiveness and cost utility of three different pneumococcal conjugate vaccines (PCVs) for Peru.

Methods: A Markov model that simulated the disease processes in a birth cohort over a lifetime, within 1,128 month cycles was used to evaluate the cost-effectiveness of 10-valent pneumococcal NTHi protein D conjugate vaccine (PHiD-CV) and 7- and 13-valent PCVs (PCV-7 and PCV-13). Expected quality-adjusted life years (QALYs), cost-savings and incremental cost-effectiveness ratios (ICERs) were calculated.

Results: Without vaccination, pneumonia was associated with the greatest health economic burden (90% of QALYs lost and 63% of lifetime direct medical costs); while acute otitis media (AOM) was responsible for 1% of QALYs lost and 25% of direct medical costs. All vaccines were predicted to be cost-effective for Peru, with PHiD-CV being most cost-effective. PHiD-CV was predicted to generate 50 more QALYs gained and required a reduced investment (-US$ 3.4 million) versus PCV-13 (discounted data), and was therefore dominant and cost saving. The probabilistic sensitivity analysis showed that PHiD-CV generated more QALYs gained at a reduced cost than PCV-13 in 84% of the simulations and less QALYs gains at a reduced cost in 16%. Additional scenarios using different assumptions on vaccine efficacies based on previous evidence were explored, but no significant change in the overall cost-effective results were observed.

Conclusions: The results of this modeling study predict that PCVs are likely to be a cost-effective strategy to help relieve the epidemiological and economic burden associated with pediatric pneumococcal and NTHi diseases for Peru. PHiD-CV is likely to be a dominant (better health gains at a reduced net cost) intervention compared to PCV-13 or PCV-7. The most significant drivers for these results are the better health and economic profile of PHiD-CV against AOM and its reduced cost per dose available through the PAHO Revolving Fund in the LAC region.

Figure 1

One-way sensitivity analysis of ICERs. A: PHiD-CV vs no vaccine; B: PCV-13 vs no vaccine. Dashed line in A shows the ICER for PCV-13 vaccine and in B shows the ICER PHiD-CV vaccine. AOM, acute otitis media; CAP, community acquired pneumonia; CI, confidence interval; GP, general practitioner; ICER, incremental cost-effectiveness ratio; PCV-13, 13-valent pneumococcal conjugate vaccine; PHiD-CV, 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine.

Figure 2

Probabilistic sensitivity analysis. A: ICER of PHiD-CV vs no vaccine; B: ICER of PHiD-CV vs PCV-13. The diagonal grey line indicates the cost-effectiveness threshold. ICER, incremental cost-effectiveness ratio; PCV-13, 13-valent pneumococcal conjugate vaccine; PHiD-CV, 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine; QALY, quality-adjusted life year.

Figure 3

Scenario analysis comparing PHiD-CV and PCV-13 vs no vaccine. A. contains scenarios generating greater variations on health effects and costs. B. contains scenarios generation smaller variations on health effects and costs. ID, invasive disease; NTHi, non-typeable Haemophilus influenzae; PCV-13, 13-valent pneumococcal conjugate vaccine; PHiD-CV, 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine.