title: Cost-effectiveness of new pneumococcal conjugate vaccines in Turkey: a decision  analytical model.
abstract: BACKGROUND
  Streptococcus pneumoniae infections, which place a considerable burden on healthcare resources, can be reduced in a cost-effective manner using a 7-valent pneumococcal conjugate vaccine (PCV-7). We compare the cost effectiveness of a 13-valent PCV (PCV-13) and a 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) with that of PCV-7 in Turkey.
  
  
  METHODS
  A cost-utility analysis was conducted and a decision analytical model was used to estimate the proportion of the Turkish population <10 years old that would experience 10 mutually exclusive outcomes over the course of 1 year from a perspective of a healthcare system. Model outcomes were adjusted according to the population demographics and region-specific serotype distribution in Turkey. Health outcomes and direct healthcare costs were simulated for PCV-7, PCV-13 and PHiD-CV.
  
  
  RESULTS
  PCV-13 and PHiD-CV are projected to have a substantial impact on pneumococcal disease in Turkey versus PCV-7, with 2,223 and 3,156 quality-adjusted life years (QALYs) and 2,146 and 2,081 life years, respectively, being saved under a 3+1 schedule. Projections of direct medical costs showed that a PHiD-CV vaccination programme would provide the greatest cost savings, offering additional savings of US$11,718,813 versus PCV-7 and US$8,235,010 versus PCV-13. Probabilistic sensitivity analysis showed that PHiD-CV dominated PCV-13 in terms of QALYs gained and cost savings in 58.3% of simulations.
  
  
  CONCLUSIONS
  Under the modeled conditions, PHiD-CV would provide the most cost-effective intervention for reducing pneumococcal disease in Turkish children.
authors.affiliation: Department of Pediatrics and Pediatric Infectious Diseases, Marmara University School of Medicine Hospital, Altunizade, Pendik, Istanbul, 34662, Turkey. mbakir@marmara.edu.tr
authors.forename: Mustafa
authors.initials: M
authors.lastname: Bakır
authors.forename: Ozden
authors.initials: O
authors.lastname: Türel
authors.forename: Oleksandr
authors.initials: O
authors.lastname: Topachevskyi
mesh_terms: D002648:Child; D002675:Child, Preschool; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D006801:Humans; D017589:Immunization Programs / Q000191:economics; D007223:Infant; D018803:Models, Economic; D011008:Pneumococcal Infections / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000191:economics*; D011788:Quality of Life; D014421:Turkey / Q000453:epidemiology; D018074:Vaccines, Conjugate / Q000191:economics
chemical_list: C538862:13-valent pneumococcal vaccine; C547294:PHiD-CV vaccine; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate