[Cost-effectiveness of universal pneumococcal vaccination in Uruguay].
OBJECTIVE
Evaluate the cost-effectiveness ratio of the program for universal vaccination with heptavalent pneumococcal conjugate vaccine (PCV7) in children under 5 years of age in Uruguay.


METHODS
A Markov model was developed that simulated a cohort of 48 000 children born in 2007 and their progress to age 76. The baseline case used a regimen of three doses with estimated protection for five years. The presumption of vaccine efficacy and effectiveness was based on studies conducted in the United States with adjustment for serotype prevalence-incidence in Uruguay. The results were expressed as the incremental cost per life year gained (LYG) and quality-adjusted life year (QALY) [gained].


RESULTS
For the baseline case, the incremental cost was US $7334.60 for each LYG and US $4655.80 for each QALY. Eight deaths and 4 882 cases of otitis, 56 cases of bacteremia-sepsis, 429 cases of pneumonia, and 7 cases of meningitis were prevented. The model shows sensitivity to variations in vaccine cost, efficacy, and pneumonia-related mortality.


CONCLUSIONS
The universal vaccination program with PCV7 in Uruguay is highly cost-effective. Therefore, it is recommended for other countries with burden of pneumococcal disease and serotype coverage similar to those of Uruguay.
Departamento de Pediatría, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay. ggiachet@gmail.com
Gustavo
G
Giachetto Larraz
Héctor
H
Telechea Ortiz
Noelia
N
Speranza Mourine
Norberto
N
Giglio
Alejandro
A
Cané
María C
MC
Pírez García
Liriana
L
Lucas Paiva
Carla
C
Pallares Barrios
Juan
J
Gesuele Ruggiero
D016470:Bacteremia / Q000401:mortality / Q000517:prevention & control; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D004653:Empyema / Q000401:mortality / Q000517:prevention & control; D005102:Health Expenditures; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D006801:Humans; D015994:Incidence; D008390:Markov Chains; D008962:Models, Theoretical; D010033:Otitis Media / Q000453:epidemiology / Q000517:prevention & control; D011008:Pneumococcal Infections / Q000191:economics / Q000401:mortality / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000191:economics*; D019057:Quality-Adjusted Life Years; D018805:Sepsis / Q000401:mortality / Q000517:prevention & control; D014583:Uruguay; D014611:Vaccination / Q000191:economics*; D018074:Vaccines, Conjugate / Q000191:economics
D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate