title: Economic evaluation of second generation pneumococcal conjugate vaccines in Norway.
abstract: BACKGROUND
  A seven valent pneumococcal conjugate vaccine (PCV7) was introduced in the Norwegian childhood immunization programme in 2006, and since then the incidence of invasive pneumococcal disease has declined substantially. Recently, two new second generation pneumococcal conjugate vaccines have become available, and an update of the economic evidence is needed. The aim of this study was to estimate incremental costs, health effects and cost-effectiveness of the pneumococcal conjugate vaccines PCV7, PCV13 and PHiD-CV in Norway.
  
  
  METHODS
  We used a Markov model to estimate costs and epidemiological burden of pneumococcal- and NTHi-related diseases (invasive pneumococcal disease (IPD), Community Acquired Pneumonia (CAP) and acute otitis media (AOM)) for a specific birth cohort. Using the most relevant evidence and assumptions for a Norwegian setting, we calculated incremental costs, health effects and cost-effectiveness for different vaccination strategies. In addition we performed sensitivity analyses for key parameters, tested key assumptions in scenario analyses and explored overall model uncertainty using probabilistic sensitivity analysis.
  
  
  RESULTS
  The model predicts that both PCV13 and PHiD-CV provide more health gains at a lower cost than PCV7. Differences in health gains between the two second generation vaccines are small for invasive pneumococcal disease but larger for acute otitis media and myringotomy procedures. Consequently, PHiD-CV saves more disease treatment costs and indirect costs than PCV13.
  
  
  CONCLUSIONS
  This study predicts that, compared to PVC13, PHiD-CV entails lower costs and greater benefits if the latter is measured in terms of quality adjusted life years. PVC13 entails more life years gained than PHiD-CV, but those come at a cost of NOK 3.1 million (∼€0.4 million) per life year. The results indicate that PHiD-CV is cost-effective compared to PCV13 in the Norwegian setting.
authors.affiliation: University of Bergen, Centre for International Health, Bergen, Norway. bjarne.robberstad@cih.uib.no
authors.forename: Bjarne
authors.initials: B
authors.lastname: Robberstad
authors.forename: Carl R
authors.initials: CR
authors.lastname: Frostad
authors.forename: Per E
authors.initials: PE
authors.lastname: Akselsen
authors.forename: Kari J
authors.initials: KJ
authors.lastname: Kværner
authors.forename: Aud K H
authors.initials: AK
authors.lastname: Berstad
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008586:Meningitis, Pneumococcal / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D008875:Middle Aged; D015233:Models, Statistical; D009664:Norway / Q000453:epidemiology; D010033:Otitis Media / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage / Q000191:economics* / Q000276:immunology; D011018:Pneumonia, Pneumococcal / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D019057:Quality-Adjusted Life Years; D018074:Vaccines, Conjugate / Q000008:administration & dosage / Q000191:economics / Q000276:immunology; D055815:Young Adult
chemical_list: C538862:13-valent pneumococcal vaccine; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; C547294:PHiD-CV vaccine; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate