The cost-effectiveness of a 13-valent pneumococcal conjugate vaccination for infants in England.
BACKGROUND
In the immunisation schedule in England and Wales, the 7-valent pneumococcal conjugate vaccine (PCV-7) was replaced by the 13-valent vaccine (PCV-13) in April 2010 after having been used since September 2006. The introduction of PCV-7 was informed by a cost effectiveness analysis using an infectious disease model which projected herd immunity and serotype replacement effects based on the post-vaccine experience in the United States at that time.


OBJECTIVE
To investigate the cost effectiveness of the introduction of PCV-13.


METHODS
Invasive disease incidence following vaccination was projected from a dynamic infectious disease model, and combined with serotype specific disease outcomes obtained from a large hospital dataset linked to laboratory confirmation of invasive pneumococcal disease. The economic impact of replacing PCV-7 with PCV-13 was compared to stopping the use of pneumococcal conjugate vaccination altogether.


RESULTS
Discontinuing PCV-7 would lead to a projected increase in invasive pneumococcal disease, costs and loss of quality of life compared to the introduction of PCV-13. However under base case assumptions (assuming no impact on non-invasive disease, maximal competition between vaccine and non-vaccine types, time horizon of 30 years, vaccine price of £49.60 a dose+£7.50 administration costs and discounting of costs and benefits at 3.5%) the introduction of PCV-13 is only borderline cost effective compared to a scenario of discontinuing of PCV-7. The intervention becomes more cost-effective when projected impact of non-invasive disease is included or the discount factor for benefits is reduced to 1.5%.


CONCLUSIONS
To our knowledge this is the first evaluation of a transition from PCV-7 to PCV-13 based on a dynamic model. The cost-effectiveness of such a policy change depends on a number of crucial assumptions for which evidence is limited, particularly the impact of PCV-13 on non-invasive disease.
Immunisation, Hepatitis and Blood Safety Department, Health Protection Services, Colindale, Health Protection Agency, London NW9 5EQ, UK. albertjan.vanhoek@hpa.org.uk
Albert Jan
AJ
van Hoek
Yoon Hong
YH
Choi
Caroline
C
Trotter
Elizabeth
E
Miller
Mark
M
Jit
D003362:Cost-Benefit Analysis; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015233:Models, Statistical; D011008:Pneumococcal Infections / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage / Q000191:economics* / Q000276:immunology*; D016896:Treatment Outcome; D014611:Vaccination / Q000191:economics* / Q000379:methods
C538862:13-valent pneumococcal vaccine; D022242:Pneumococcal Vaccines