title: [Economic evaluation of an infant immunization program in Mexico, based on 13-valent pneumococcal conjugated vaccines].
abstract: OBJECTIVE
  Vaccination is an effective intervention for reduce child morbidity and mortality associated to pneumococcus. The availability of new anti-pneumococcal vaccines makes it necessary to evaluate its potential impact on public health and costs related to their implementation. The aim of this study was to estimate the cost-effectiveness and cost-utility of immunization strategies based on pneumococcal conjugated vaccines (PCV's) currently available in Mexico from a third payer perspective.
  
  
  METHODS
  A decision tree model was developed to assess both, economic and health impact, of anti-pneumococcal vaccination in children <2 years (lifetime time horizon, discount rate: 5% annual). Comparators were: no-vaccination (reference) and strategies based on 7, 10 and 13-valent PCV's. Effectiveness measures were: child deaths avoided, life-years gained (LYG) and quality adjusted life years (QALY's) gained. Effectiveness, utility, local epidemiology and cost of treating pneumococcal diseases were extracted from published sources. Univariate sensitivity analysis were performed.
  
  
  RESULTS
  Immunization dominates no-vaccination: strategy based on 13-valent vaccine prevented 16.205 deaths, gained 331.230 LY's and 332.006 QALY's and saved US$1.307/child vaccinated. Strategies based on 7 and 10-valent PCV's prevented 13.806 and 5.589 deaths, gained 282.193 and 114.251 LY's, 282.969 and 114.972 QALY's and saved US$1.084 and US$731/child vaccinated, respectively. These results were robust to variations in herd immunity and lower immunogenicity of 10-valent vaccine.
  
  
  CONCLUSIONS
  In Mexico, immunization strategies based on 7, 10 and 13-valent PCV's would be cost-saving interventions, however, health outcomes and savings of the strategy based on 13-valent vaccine are greater than those estimated for 7 and 10-valent PCV's.
authors.affiliation: Pfizer S.A. de C.V., México D.F., México. emilio.mucino@pfizer.com
authors.forename: Emilio
authors.initials: E
authors.lastname: Muciño-Ortega
authors.forename: Joaquín Federico
authors.initials: JF
authors.lastname: Mould-Quevedo
authors.forename: Raymond
authors.initials: R
authors.lastname: Farkouh
authors.forename: David
authors.initials: D
authors.lastname: Strutton
mesh_terms: D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003663:Decision Trees; D016527:Drug Costs; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D006801:Humans; D017589:Immunization Programs / Q000191:economics*; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007349:Insurance, Health, Reimbursement; D008800:Mexico; D018803:Models, Economic; D009313:National Health Programs / Q000191:economics*; D011008:Pneumococcal Infections / Q000191:economics* / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000191:economics*; D019057:Quality-Adjusted Life Years; D013997:Time Factors; D016896:Treatment Outcome; D018074:Vaccines, Conjugate / Q000191:economics
chemical_list: C538863:10-valent pneumococcal vaccine; C538862:13-valent pneumococcal vaccine; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate