title: Cost-effectiveness of introducing the 10-valent pneumococcal conjugate vaccine into the universal immunisation of infants in Brazil.
abstract: BACKGROUND
  Cost-effectiveness studies have been increasingly part of decision processes for incorporating new vaccines into the Brazilian National Immunisation Program. This study aimed to evaluate the cost-effectiveness of 10-valent pneumococcal conjugate vaccine (PCV10) in the universal childhood immunisation programme in Brazil.
  
  
  METHODS
  A decision-tree analytical model based on the ProVac Initiative pneumococcus model was used, following 25 successive cohorts from birth until 5 years of age. Two strategies were compared: (1) status quo and (2) universal childhood immunisation programme with PCV10. Epidemiological and cost estimates for pneumococcal disease were based on National Health Information Systems and literature. A 'top-down' costing approach was employed. Costs are reported in 2004 Brazilian reals. Costs and benefits were discounted at 3%.
  
  
  RESULTS
  25 years after implementing the PCV10 immunisation programme, 10 226 deaths, 360 657 disability-adjusted life years (DALYs), 433 808 hospitalisations and 5 117 109 outpatient visits would be avoided. The cost of the immunisation programme would be R$10 674 478 765, and the expected savings on direct medical costs and family costs would be R$1 036 958 639 and R$209 919 404, respectively. This resulted in an incremental cost-effectiveness ratio of R$778 145/death avoided and R$22 066/DALY avoided from the society perspective.
  
  
  CONCLUSIONS
  The PCV10 universal infant immunisation programme is a cost-effective intervention (1-3 GDP per capita/DALY avoided). Owing to the uncertain burden of disease data, as well as unclear long-term vaccine effects, surveillance systems to monitor the long-term effects of this programme will be essential.
authors.affiliation: Clinic of Infectious and Parasitic Diseases, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. anasartori@gmail.com
authors.forename: Ana Marli Christovam
authors.initials: AM
authors.lastname: Sartori
authors.forename: Patricia Coelho
authors.initials: PC
authors.lastname: de Soárez
authors.forename: Hillegonda Maria Dutilh
authors.initials: HM
authors.lastname: Novaes
mesh_terms: D001938:Brazil; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data*; D007223:Infant; D007231:Infant, Newborn; D022242:Pneumococcal Vaccines / Q000008:administration & dosage / Q000191:economics* / Q000600:supply & distribution; D018074:Vaccines, Conjugate
chemical_list: C538863:10-valent pneumococcal vaccine; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate