Pharmacoeconomic evaluation of 10- and 13-valent pneumococcal conjugate vaccines.
BACKGROUND
There are three different pneumococcal vaccines available for infants, each oriented to a specific set of serotypes. The vaccination of newborns will prevent pneumococcal disease in this vaccinated group via direct effects, and will also affect the non-vaccinated population through indirect or "herd" immunity.


OBJECTIVE
To develop a model that compares the health and economic consequences between the three vaccines.


METHODS
We developed a simulation model for an entire population, providing vaccine to children less than 2 years of age. The vaccines varied by serotypes covered and included a 7- (4, 6B, 9V, 14, 18C, 19F and 23F), 10- (1, 4, 5, 6B, 7F, 9V, 14, 18C, 19F and 23F) and 13-valent (1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F and 23F) vaccines. The base case was PCV-7, and clinical and economic outcomes were estimated for the vaccinated persons and for other persons through assumptions about a herd effect. By comparison, clinical and economic outcomes for the population were also estimated for the 10 and 13 serotype vaccines.


RESULTS
In the base case (PCV-7), with the seven serotype vaccine, there were 9.38 cases of hospitalized pneumonia, 0.22 cases of meningitis, 3.69 cases of bacteremia, 60.19 cases of otitis media, and 373 cases of pneumonia, per 100,000 persons in the population, at all ages. With the 10-valent vaccine and a herd effect, invasive pneumonia fell to 8.71 cases, meningitis to 0.21 cases, and bacteremia to 3.39 cases. Otitis media fell to 57 cases and pneumonia to 344 cases. There were further reductions with the 13-valent vaccine, with invasive pneumonia falling to 8.37 cases, bacteremia to 3.33 cases, otitis media to 51.9 cases and all-cause pneumonia to 336.2 cases. Among the vaccines evaluated, PCV-13 was associated with the lowest health services costs and the greatest improved health outcomes.


CONCLUSIONS
Increased serotype coverage of the 13-valent vaccine is expected to have a substantial public health and economic impact on infectious disease, when considering direct and indirect effects.
Chuck
Anderson W
AW
Institute of Health Economics, Edmonton, Alberta, Canada. achuck@ihe.ca
Jacobs
Philip
P
Tyrrell
Gregory
G
Kellner
James D
JD
D000416:Alberta / Q000453:epidemiology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D018448:Models, Immunological; D010033:Otitis Media / Q000191:economics / Q000201:enzymology / Q000453:epidemiology / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000009:adverse effects / Q000191:economics* / Q000276:immunology*; D011018:Pneumonia, Pneumococcal / Q000191:economics / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control
D022242:Pneumococcal Vaccines