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. 2025 Dec;28(1):696-708.
doi: 10.1080/13696998.2025.2499333. Epub 2025 May 14.

Cost-effectiveness analysis of implementing 20-valent pneumococcal conjugate vaccine into the Romanian pediatric national immunization program

Alin Preda  1 , An Ta  2 , Elizabeth Vinand  2 , Veronica Purdel  1 , Ana Maria Zdrafcovici  1 , Aleksandar Ilic  3 , Johnna Perdrizet  4
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Free article

Cost-effectiveness analysis of implementing 20-valent pneumococcal conjugate vaccine into the Romanian pediatric national immunization program

Alin Preda et al. J Med Econ. 2025 Dec.
Free article

Abstract

Introduction: Despite the inclusion of pneumococcal conjugate vaccines (PCV) in the pediatric national immunization program (NIP) since 2017, Romania continues to face a substantial clinical, economic, and societal burden of pneumococcal disease. Higher-valent vaccines, such as 20-valent PCV (PCV20), offer broader serotype coverage versus the current standard of care (13-valent PCV; PCV13) with the potential to reduce disease burden. To test this, we conducted a cost-effectiveness analysis of switching from PCV13 or a potential future comparator (15-valent PCV; PCV15), both under a 2 + 1 schedule, to PCV20 under a 3 + 1 schedule in the Romanian pediatric NIP.

Methods: A population-based, multi-cohort Markov model with a target population of children aged <2 years was utilized to estimate the cost and health impact of PCV20 versus lower-valent comparators over 10 years. The model adopted a Romanian societal perspective, encompassing both direct and indirect costs, with an annual cycle. Sensitivity and scenario analyses were conducted to assess the robustness of the model and its assumptions.

Results: In the base-case analysis, PCV20 demonstrated dominance versus PCV13 and PCV15 (i.e. was more effective and less costly), with total predicted cost-savings of 79,123,267 and 206,623,098 Romanian Leu, respectively, plus reduction in pneumococcal disease cases by 246,245 and 223,914, respectively. The majority of sensitivity and scenario analyses of both pairwise comparisons were aligned with the base case.

Conclusion: The results of this analysis indicate that PCV20 implementation into the Romanian pediatric NIP would greatly reduce pneumococcal disease burden and would be a cost-effective approach versus PCV13 or PCV15 from a societal perspective over 10 years.

Keywords: I15; I18; PCV13; PCV15; PCV20; Romania; cost-effectiveness; national immunization program; pediatric; pneumococcal conjugate vaccination; vaccination.

Plain language summary

Diseases caused by a bacteria called Streptococcus pneumoniae are referred to as pneumococcal diseases. People can be protected against pneumococcal diseases by receiving pneumococcal conjugate vaccines. Some countries, such as Romania, provide free vaccinations for residents. Authorities need to know how effective and expensive vaccines are in order to choose the most cost-effective option. In this study, the scientists wanted to find out which pneumococcal conjugate vaccine would be the most cost-effective for vaccinating Romanian children aged under 2 years. The scientists predicted the effects of vaccinating Romanian children with a pneumococcal conjugate vaccine called PCV20 versus two others called PCV13 and PCV15. As vaccines protect people who are vaccinated and can also reduce the spread of disease, the scientists calculated the effects on the whole population of Romania. The scientists predicted the impact of each vaccine option on the number of people experiencing pneumococcal diseases as well as healthcare costs. The calculated costs included those incurred by the Romanian healthcare system by giving children the vaccines and treating people with pneumococcal diseases. The scientists predicted that if children were vaccinated with PCV20 instead of PCV13 or PCV15, fewer people would experience pneumococcal diseases and the total cost to the Romanian healthcare system would be reduced. These results could help authorities make decisions about which pneumococcal conjugate vaccine to give to Romanian children. The results could also help people understand how authorities decide which vaccine to give to children to prevent pneumococcal diseases.

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