title: A cost-effectiveness analysis of a 10-valent pneumococcal conjugate vaccine in children in six Latin American countries.
abstract: BACKGROUND
  A recently developed 10-valent pneumococcal non-typeable H influenzae protein D-conjugate vaccine (PHiD-CV) is expected to afford protection against more than two thirds of isolates causing IPD in children in Latin America, and also against acute otitis media caused by both Spn and NTHi. The objective of this study is to assess the cost-effectiveness of PHiD-CV in comparison to non-vaccination in children under 10 years of age in Argentina, Brazil, Chile, Colombia, Mexico and Peru.
  
  
  METHODS
  We used a static, deterministic, compartmental simulation model. The dosing regimen considered included three vaccine doses (at 2 months, 4 months and 6 months) and a booster dose (at 13 months) (3 + 1 schedule). Model outcomes included number of cases prevented, deaths averted, quality-adjusted life-years (QALYs) gained and costs. Discount for costs and benefits of long term sequelae was done at 3.5%, and currency reported in 2008-2009 U$S varying between countries.
  
  
  RESULTS
  The largest effect in case prevention was observed in pneumococcal meningitis (from 27% in Peru to 47% in Colombia), neurologic sequelae after meningitis (from 38% in Peru to 65% in Brazil) and bacteremia (from 42% in Argentina to 49% in Colombia). The proportion of predicted deaths averted annually ranged from 18% in Peru to 33% in Brazil. Overall, the health benefits achieved with PHiD-CV vaccination resulted in a lower QALY loss (from 15% lower in Peru to 26% in Brazil). At a cost of USD 20 per vaccine dose, vaccination was cost-effective in all countries, from being cost saving in Chile to a maximum Incremental Cost-effectiveness Ratio of 7,088 US$ Dollars per QALY gained. Results were robust in the sensitivity analysis, and scenarios with indirect costs affected results more than those with herd immunity.
  
  
  CONCLUSIONS
  The incorporation of the 10-valent pneumococcal conjugate vaccine into routine infant immunization programs in Latin American countries could be a cost-effective strategy to improve infant population health in the region.
authors.affiliation: IECS, Instituto de Efectividad Clínica y Sanitaria, Dr, Emilio Ravignani 2024, Buenos Aires C1414CPV, Argentina. garciamarti@iecs.org.ar.
authors.forename: Sebastián García
authors.initials: SG
authors.lastname: Martí
authors.forename: Lisandro
authors.initials: L
authors.lastname: Colantonio
authors.forename: Ariel
authors.initials: A
authors.lastname: Bardach
authors.forename: Julieta
authors.initials: J
authors.lastname: Galante
authors.forename: Analía
authors.initials: A
authors.lastname: Lopez
authors.forename: Joaquín
authors.initials: J
authors.lastname: Caporale
authors.forename: Gerhart
authors.initials: G
authors.lastname: Knerer
authors.forename: Jorge Alberto
authors.initials: JA
authors.lastname: Gomez
authors.forename: Federico
authors.initials: F
authors.lastname: Augustovski
authors.forename: Andrés
authors.initials: A
authors.lastname: Pichon-Riviere