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. 2021 Apr 27:2021:7494965.
doi: 10.1155/2021/7494965. eCollection 2021.

Cost-Effectiveness and Budget Impact Analyses of Pneumococcal Vaccination in Indonesia

Auliya A Suwantika  1   2 , Neily Zakiyah  1   2 , Rizky Abdulah  1   2 , Vensya Sitohang  3 , Gertrudis Tandy  3 , Atiek Anartati  4 , Tetrawindu Hidayatullah  4 , Putri Herliana  4 , Sri R Hadinegoro  5
Affiliations

Cost-Effectiveness and Budget Impact Analyses of Pneumococcal Vaccination in Indonesia

Auliya A Suwantika et al. J Environ Public Health. .

Abstract

As a country with the high number of deaths due to pneumococcal disease, Indonesia has not yet included pneumococcal vaccination into the routine program. This study aimed to analyse the cost-effectiveness and the budget impact of pneumococcal vaccination in Indonesia by developing an age-structured cohort model. In a comparison with no vaccination, the use of two vaccines (PCV10 and PCV13) within two pricing scenarios (UNICEF and government contract price) was taken into account. To estimate the cost-effectiveness value, a 5-year time horizon was applied by extrapolating the outcome of the individual in the modelled cohort until 5 years of age with a 1-month analytical cycle. To estimate the affordability value, a 6-year period (2019-2024) was applied by considering the government's strategic plan on pneumococcal vaccination. In a comparison with no vaccination, the results showed that vaccination would reduce pneumococcal disease by 1,702,548 and 2,268,411 cases when using PCV10 and PCV13, respectively. Vaccination could potentially reduce the highest treatment cost from the payer perspective at $53.6 million and $71.4 million for PCV10 and PCV13, respectively. Applying the UNICEF price, the incremental cost-effectiveness ratio (ICER) from the healthcare perspective would be $218 and $162 per QALY-gained for PCV10 and PCV13, respectively. Applying the government contract price, the ICER would be $987 and $747 per QALY-gained for PCV10 and PCV13, respectively. The result confirmed that PCV13 was more cost-effective than PCV10 with both prices. In particular, introduction cost per child was estimated to be $0.91 and vaccination cost of PCV13 per child (3 doses) was estimated to be $16.61 and $59.54 with UNICEF and government contract prices, respectively. Implementation of nationwide vaccination would require approximately $73.3-$75.0 million (13-14% of routine immunization budget) and $257.4-$263.5 million (45-50% of routine immunization budget) with UNICEF and government contract prices, respectively. Sensitivity analysis showed that vaccine efficacy, mortality rate, and vaccine price were the most influential parameters affecting the ICER. In conclusion, pneumococcal vaccination would be a highly cost-effective intervention to be implemented in Indonesia. Yet, applying PCV13 with UNICEF price would give the best cost-effectiveness and affordability values on the routine immunization budget.

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Conflict of interest statement

The authors declare that there are no conflicts of interest regarding the publication of this paper.

Figures

Figure 1
Figure 1
Decision analytic model.
Figure 2
Figure 2
(a) Potential number of cases averted (<5 years of age) through vaccination. (b) Cumulative number of saved treatment cost from all perspectives (2019–2024).
Figure 3
Figure 3
(a) Cost-effectiveness values of pneumococcal vaccination. (b) One-way sensitivity analysis.
See this image and copyright information in PMC

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