Cost-Effectiveness Analysis of Routine Use of 15-Valent Pneumococcal Conjugate Vaccine in the US Pediatric Population

Abstract

This study evaluated the clinical and economic impact of routine pediatric vaccination with the 15-valent pneumococcal conjugate vaccine (PCV15, V114) compared with the 13-valent PCV (PCV13) from a societal perspective in the United States (US). A Markov decision-analytic model was constructed to estimate the outcomes for the entire US population over a 100-year time horizon. The model estimated the impact of V114 versus PCV13 on pneumococcal disease (PD) incidence, post meningitis sequalae, and deaths, taking herd immunity effects into account. V114 effectiveness was extrapolated from the observed PCV13 data and PCV7 clinical trials. Costs (2021$) included vaccine acquisition and administration costs, direct medical costs for PD treatment, direct non-medical costs, and indirect costs, and were discounted at 3% per year. In the base case, V114 prevented 185,711 additional invasive pneumococcal disease, 987,727 all-cause pneumonia, and 11.2 million pneumococcal acute otitis media cases, compared with PCV13. This led to expected gains of 90,026 life years and 96,056 quality-adjusted life years with a total saving of $10.8 billion. Sensitivity analysis showed consistent results over plausible values of key model inputs and assumptions. The findings suggest that V114 is a cost-saving option compared to PCV13 in the routine pediatric vaccination program.

Keywords: PCV15; V114; cost-effectiveness; pediatric vaccination; pneumococcal diseases; public health impact.

Figure 1

Decision analytic model of pediatric pneumococcal vaccination. Abbreviations: PCV13 = 13-valent pneumococcal conjugate vaccine; V114 = 15-valent pneumococcal conjugate vaccine; AOM = acute otitis media. Notes: (1) The clone nodes are identical in structure to the original nodes but can have different probabilities of events. (2) general background mortality applies to all health states.

Figure 2

One-way sensitivity analysis results (showing the most impactful parameters). Abbreviations: ICER = incremental cost-effectiveness ratio; PCV13 = 13-valent pneumococcal conjugate vaccine; V114 = 15-valent pneumococcal conjugate vaccine; VE = vaccine effectiveness; IPD = invasive pneumococcal disease; AOM = acute otitis media; ST = serotype; QALY = quality-adjusted life year. Notes: Tornado diagram showing the results of the one-way sensitivity analysis. The purple bars show the change in ICER from the base case when the higher value of an input was used whereas the light blue bars show the change in ICER from the base case when the lower value of the selected input was used while all other inputs remain constant.

Figure 3

Scattered plot of probabilistic sensitivity analysis. Abbreviations: QALY = quality-adjusted live year; PSA = probabilistic sensitivity analysis.