title: Cost effectiveness of the new pneumococcal vaccines: a systematic review of European studies.
abstract: BACKGROUND
  Diseases caused by Streptococcus pneumoniae (pneumococcus) are a major global public health problem. Despite their importance, information on the burden of the different pneumococcal diseases is limited and estimates vary widely.
  
  
  OBJECTIVE
  We critically reviewed the full economic evaluations (FEEs) on the new pneumococcal conjugate vaccines (PCVs) conducted in the European Union (EU) to assess their potential contribution to public decision making. We selected the FEEs focussed on PCV-10 and PCV-13 and published in English from January 2007 until June 2013. We screened the selected articles to assess their main methodological features using a common checklist composed of epidemiological, clinical and economic items.
  
  
  RESULTS
  All the ten studies selected were based on modelling and the time horizon was always long term. Two studies focused on adults, the remaining eight on infants. Only one study based herd immunity on national data, eight used foreign data or modelling and the last did not consider it. National prices and tariffs were claimed to be sources for unit costs in all studies; however, half of them assumed price parity when one vaccine was not yet marketed, and the figures varied within the countries where more than one study was conducted. Conclusions supported the economic utility of pneumococcal vaccination in all studies, raising some concern only in (i) the independent study, which found that PCV-13 was borderline cost effective, and (ii) the study sponsored by both manufacturers, which estimated an incremental ratio slightly above the national threshold for both PCV-10 and PCV-13.
  
  
  CONCLUSIONS
  The European studies we analysed are mostly based on weak sources of data. Because of the limited information on vaccine effectiveness and lack of epidemiological and economic data, the need for extensive recourse to assumptions leads to great within- and between-study variability generated by authors' choices.
authors.affiliation: CESAV, Centre for Health Economics, IRCCS Institute for Pharmacological Research 'Mario Negri', Via Camozzi, 3 c/o Villa Camozzi, Ranica, 24020, Bergamo, Italy.
authors.forename: Katelijne
authors.initials: K
authors.lastname: van de Vooren
authors.forename: Silvy
authors.initials: S
authors.lastname: Duranti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Curto
authors.forename: Livio
authors.initials: L
authors.lastname: Garattini
mesh_terms: D003365:Costs and Cost Analysis; D005060:Europe; D006801:Humans; D011008:Pneumococcal Infections / Q000191:economics / Q000276:immunology / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000191:economics* / Q000276:immunology; D018074:Vaccines, Conjugate / Q000191:economics / Q000276:immunology
chemical_list: C586648:10-valent pneumococcal conjugate vaccine; C538862:13-valent pneumococcal vaccine; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate