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. 2022 Nov 30;18(6):2114252.
doi: 10.1080/21645515.2022.2114252. Epub 2022 Sep 7.

Cost-utility and cost-benefit analysis of pediatric PCV programs in Egypt

J P Sevilla  1   2 , Daria Burnes  1 , Rehab Zakaria El Saie  3 , Hammam Haridy  4 , Matt Wasserman  5 , Sarah Pugh  6 , Johnna Perdrizet  5 , David Bloom  1   2
Affiliations

Cost-utility and cost-benefit analysis of pediatric PCV programs in Egypt

J P Sevilla et al. Hum Vaccin Immunother. .

Abstract

New vaccine introductions (NVIs) raise issues of value for money (VfM) for self-financing middle-income countries like Egypt. We evaluate a pediatric pneumococcal conjugate vaccine (PCV) NVI in Egypt from health payer and societal perspectives, using cost-utility and cost-benefit analysis (CUA, CBA). We evaluate vaccinating 100 successive birth cohorts with the 13-valent PCV ("PCV13") and the 10-valent PCV ("PCV10") relative to no vaccination and each other. We quantify health effects with a disease incidence projection model and a multiple-cohort static disease model. Our CBA uses a health-augmented lifecycle model to generate willingness-to-pay for health gains from which we calculate rates of return (RoR). We obtain parameters from the published literature. We perform deterministic and probabilistic sensitivity analysis. Our base-case CUA finds incremental cost-effectiveness ratios (ICERs) for PCV13 and PCV10 relative to no program of $926 (95% confidence interval $512-$1,735) and $1,984 ($1,186-$3,805) per quality-adjusted life year (QALY), respectively; and for PCV13 relative to PCV10 of $174 ($88-$331) per QALY. Our base-case CBA finds RoRs to PCV13 and PCV10 relative to no program of 488% (188-993%) and 164% (33-336%), respectively, and to PCV13 relative to PCV10 of 3109% (1410-6602%). Both CUA and CBA find PCV13 to be good VfM relative to PCV10.

Keywords: Egypt; Pneumococcal conjugate vaccine; cost-benefit analysis; economic evaluation; invasive pneumococcal disease; otitis media; pneumococcal disease; pneumonia; rate of return; vaccines.

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Conflict of interest statement

This study was led by Data for Decisions LLC (DfD) with funding from Pfizer Inc. JP Sevilla and Daria Burnes are employees of DfD and in that capacity have worked on this and other studies funded by grants from Pfizer and GSK to DfD. David Bloom is an external consultant to DfD and in that capacity has worked on this and other studies funded by grants from Pfizer and GSK to DfD. JP Sevilla and David Bloom in their personal capacities have received compensation from Pfizer and GSK for providing consulting services and for speaking and participating in meetings and advisory boards. Johnna Perdrizet, Sarah Pugh and Matt Wasserman are employees of Pfizer Inc. Rehab Zakaria El Saie is an employee of Pfizer Egypt. Hammam Haridy is an employee of Pfizer Gulf. Johnna Perdrizet, Sarah Pugh, Matt Wasserman, Rehab Zakaria El Saie, and Hammam Haridy held Pfizer stock or stock options at the time of the study. Pfizer Inc. employs Johnna Perdrizet, Sarah Pugh, Matt Wasserman, Rehab Zakaria El Saie, and Hammam Haridy, but otherwise played no role in study design, data collection and analysis, decision to publish, or preparation of the article.

Figures

Figure 1.
Figure 1.
(a) Markov cycle tree of Streptococcus pneumoniae. The structure of the “Program B” branch is the same as that of the “Program A” branch. SP: Streptococcus pneumoniae; OCAP: Outpatient pneumococcal pneumonia; ICAP: Inpatient pneumococcal pneumonia; AOM: Pneumococcal acute otitis media; OCAP_TD: Temporary disability after OCAP; ICAP_TD: Temporary disability after ICAP; MEN_TD: Temporary disability after meningitis; BACT_TD: Temporary disability after bacteremia; AOM_TD: Temporary disability after AOM; NDI: Neurodevelopmental impairment after meningitis. (b) Cycle tree for at least one major sequela from inpatient pneumonia. The structures of nodes C, D, E, and F in Figure 1a are the same as that of node B in Figure 1b. (c) Cycle tree for the multiple sequelae state.
Figure 1.
Figure 1.
(Continued).
Figure 2.
Figure 2.
Incidence rate projection model results. Overall invasive pneumococcal disease (IPD) incidence rate projections. Projections under a PCV10 program (red); Projections under a PCV13 program PCV13 (blue). Horizontal axis is time (in years) since the introduction of a universal pediatric PCV program.
Figure 3.
Figure 3.
Incidence rate projection model results. Effect of pediatric PCVs against invasive pneumococcal disease. PCV effect = ((no program incidence – program incidence)/no program incidence)*100. PCV10 effects (red); PCV13 effects (blue). Population: 2016 and 2023 birth cohorts. Base-case analysis.
Figure 4.
Figure 4.
Markov model results. Quality-adjusted life year gains for select birth cohorts. Base-case analysis.
Figure 5.
Figure 5.
Health-Augmented lifecycle model results. Base-case analysis using the 2016 birth cohort. Value of a statistical disability year (black); Value of a statistical life year (dashed black); Full income (green); Full consumption (red); Annual earnings (blue).
Figure 6.
Figure 6.
Markov model results. Vaccination effects on lifetime survival probability and lifetime health utility. Base-case analysis using the 2016 and 2023 birth cohorts. PCV10 effects (red); PCV13 effects (blue).
Figure 7.
Figure 7.
Willingness to pay (WTP) results. WTP for mortality risk reductions and morbidity risk reductions. Base-case analysis using the 2016 and 2023 birth cohorts. WTP for PCV10 (red); WTP for PCV13 (blue).
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