title: Assessment of health benefits and cost-effectiveness of 10-valent and 13-valent pneumococcal conjugate vaccination in Kenyan children.
abstract: BACKGROUND
  The GAVI Alliance supported 10-valent pneumococcal conjugate vaccine (PCV10) introduction in Kenya. We estimated the cost-effectiveness of introducing either PCV10 or the 13-valent vaccine (PCV13) from a societal perspective and explored the incremental impact of including indirect vaccine effects.
  
  
  METHODS
  The costs and effects of pneumococcal vaccination among infants born in Kenya in 2010 were assessed using a decision analytic model comparing PCV10 or PCV13, in turn, with no vaccination. Direct vaccine effects were estimated as a reduction in the incidence of pneumococcal meningitis, sepsis, bacteraemic pneumonia and non-bacteraemic pneumonia. Pneumococcal disease incidence was extrapolated from a population-based hospital surveillance system in Kilifi and adjustments were made for variable access to care across Kenya. We used vaccine efficacy estimates from a trial in The Gambia and accounted for serotype distribution in Kilifi. We estimated indirect vaccine protection and serotype replacement by extrapolating from the USA. Multivariable sensitivity analysis was conducted using Monte Carlo simulation. We assumed a vaccine price of US$ 3.50 per dose.
  
  
  RESULTS
  The annual cost of delivering PCV10 was approximately US$14 million. We projected a 42.7% reduction in pneumococcal disease episodes leading to a US$1.97 million reduction in treatment costs and a 6.1% reduction in childhood mortality annually. In the base case analysis, costs per discounted DALY and per death averted by PCV10, amounted to US$ 59 (95% CI 26-103) and US$ 1,958 (95% CI 866-3,425), respectively. PCV13 introduction improved the cost-effectiveness ratios by approximately 20% and inclusion of indirect effects improved cost-effectiveness ratios by 43-56%. The break-even prices for introduction of PCV10 and PCV13 are US$ 0.41 and 0.51, respectively.
  
  
  CONCLUSIONS
  Introducing either PCV10 or PCV13 in Kenya is highly cost-effective from a societal perspective. Indirect effects, if they occur, would significantly improve the cost-effectiveness.
authors.affiliation: Kenya Medical Research Institute/Wellcome Trust Programme, Nairobi, Kenya. payieko@nairobi.kemri-wellcome.org
authors.forename: Philip
authors.initials: P
authors.lastname: Ayieko
authors.forename: Ulla K
authors.initials: UK
authors.lastname: Griffiths
authors.forename: Moses
authors.initials: M
authors.lastname: Ndiritu
authors.forename: Jennifer
authors.initials: J
authors.lastname: Moisi
authors.forename: Isaac K
authors.initials: IK
authors.lastname: Mugoya
authors.forename: Tatu
authors.initials: T
authors.lastname: Kamau
authors.forename: Mike
authors.initials: M
authors.lastname: English
authors.forename: J Anthony G
authors.initials: JA
authors.lastname: Scott
mesh_terms: D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D006801:Humans; D007223:Infant; D007342:Insurance Benefits / Q000191:economics*; D007630:Kenya; D022242:Pneumococcal Vaccines / Q000191:economics*; D012680:Sensitivity and Specificity; D014611:Vaccination / Q000191:economics*; D018074:Vaccines, Conjugate / Q000191:economics*
chemical_list: C538863:10-valent pneumococcal vaccine; C538862:13-valent pneumococcal vaccine; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate