title: Cost-effectiveness of pneumococcal conjugate vaccines of 7, 10, and 13 valences in Colombian children.
abstract: BACKGROUND
  Currently there are three pneumococcal conjugate vaccines with different coverage of serotypes for use in children under one year. We evaluate the cost-effectiveness of the introduction of pneumococcal conjugate vaccines of 7, 10, and 13 valences in the Colombian EPI.
  
  
  METHODS
  A Markov model, which followed a cohort of children under one year to life expectancy, was developed. Parameters of occurrence and care costs were based on data from National Health System and literature review. PCV-7 is a dominated strategy. PCV-10 and PCV-13 were each compared to no vaccination or PCV-10 vaccination, respectively. A 2+1 schedule and a vaccination price of US$ 14.00, US$ 14.85 and US$ 16.34 per dose were assumed in the base case for PCV-7, -10, and PCV-13 vaccines.
  
  
  RESULTS
  Introduction of PCV-13 rather than PCV-10 increases the number of life years gained (LYG). From the societal perspective, in the 'competing choice' framework cost per LYG was US$ 1837 with PCV-10 and US$ 9514 with PCV-13, while PCV-7 is a dominated strategy. The ICER of PCV-13 is above the per capita Gross Domestic Product. Incremental cost-effectiveness ratios (ICERs) were influenced mainly by effectiveness against radiologically-confirmed pneumonia and AOM, vaccine price, and discount rate.
  
  
  CONCLUSIONS
  Routine vaccination against Streptococcus pneumoniae in Colombia would be cost-effective with PCV-10, with ICER below the per-capita GDP, but its inclusion requires evaluating the budget impact. PCV-13 would prevent more disease and deaths with a higher LYG, but PCV-10 would save more cost to the healthcare system due its higher impact in the prevention of AOM. There is limitation in the clinical evidence of both strategies.
authors.affiliation: Epidemiology and Public Health Evaluation Group, Department of Public Health, Universidad Nacional de Colombia, Carrera 30 # 45 - 03, Office 150, Bogotá DC Colombia. cacastanedao@unal.edu.co
authors.forename: Carlos
authors.initials: C
authors.lastname: Castañeda-Orjuela
authors.forename: Nelson
authors.initials: N
authors.lastname: Alvis-Guzmán
authors.forename: Martha
authors.initials: M
authors.lastname: Velandia-González
authors.forename: Fernando
authors.initials: F
authors.lastname: De la Hoz-Restrepo
mesh_terms: D015331:Cohort Studies; D003105:Colombia / Q000453:epidemiology; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D006801:Humans; D007223:Infant; D008390:Markov Chains; D018803:Models, Economic; D011008:Pneumococcal Infections / Q000453:epidemiology / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000191:economics*
chemical_list: C538863:10-valent pneumococcal vaccine; C538862:13-valent pneumococcal vaccine; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D022242:Pneumococcal Vaccines