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. 2025 Jan;98(1):111-117.
doi: 10.15386/mpr-2674. Epub 2025 Jan 31.

Cost-effectiveness analysis of the 13-valent pneumococcal conjugate vaccine administered to children under 5 years of age in the Republic of Moldova

Ana-Mihaela Balanuta  1   2 , Dina Bujor  1   2 , Angela Paraschiv  3 , Adela Horodisteanu-Banuh  2 , Ninel Revenco  1   2
Affiliations

Cost-effectiveness analysis of the 13-valent pneumococcal conjugate vaccine administered to children under 5 years of age in the Republic of Moldova

Ana-Mihaela Balanuta et al. Med Pharm Rep. 2025 Jan.

Abstract

Background: The Moldovan health authorities introduced the 13 valent pneumococcal conjugate vaccine into the national immunization schedule for children in 2013. This study aimed to evaluate the cost-effectiveness of the pneumococcal conjugate vaccine compared to a no-vaccination strategy in children under 5 Years of age in the Republic of Moldova.

Methods: We used UNIVAC (version 1.7), a static decision model, to evaluate the health and economic outcomes of vaccination in a single-cohort of children under five years. We modeled vaccine introduction over 10 birth cohorts starting in 2013. We assumed a 2+1 (two doses + booster) schedule and a vaccination price of US$ 16.34 per dose. We used locally-specific data for pneumonia incidence, mortality, treatment, and costs. Model outcomes included pneumonia cases, hospitalizations, deaths, disability-adjusted life years, and costs presented in USD. Cost-effectiveness was reported as Incremental Cost Effectiveness Ratio. The Incremental Cost Effectiveness Ratio was calculated to estimate the additional cost to save an additional life year.

Results: From the governmental health sector the Incremental Cost Effectiveness Ratio was $5939 and from society perspective, $7272, respectively. Withal cost per disability-adjusted life years (DALY) averted was US$ 6311. PCV-13 was projected to prevent 2310 hospitalizations due to pneumococcal disease, including 118 deaths. Vaccination could potentially reduce the highest treatment cost from the payer perspective at $ 4 081 412 for the 13 valent pneumococcal conjugate vaccine.

Conclusion: This study evidenced that cost per DALY averted is US$ 6311, which is between one and three times Gross Domestic Product (GDP) per capita, these findings extrapolate PCV-13 as a cost-effective intervention. Considering the scenario of Republic of Moldova the PCV program is a cost effective intervention and justifies the introduction of PCV into routine immunization schedule throughout the country in order to reduce morbidity and mortality among the under-five-year-old children.

Keywords: cost-effectiveness; immunization programs; pneumococcal; pneumococcal vaccines.

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Figures

Figure 1
Figure 1
Cost-effectiveness of pharmaceutical strategies to prevent pneumococcal disease in young children: a decision-support model for use in low-income and middle-income countries.
Figure 2
Figure 2
UNIVAC generated data - total disease events. AOM - Acute otitis media; NPNM - Non-Pneumonia, Non-Meningitis; MS - meningitis sequelae.
Figure 3
Figure 3
ICER scatter plot. DALY averted - Disability adjusted life year averted; GDP - Gross Domestic Product per capita.
Figure 4
Figure 4
Cost-effectiveness acceptability curve. GDP - Gross Domestic Product per capita.
See this image and copyright information in PMC

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