title: Cost-effectiveness analysis of pneumococcal conjugate vaccines in preventing pneumonia in Peruvian children.
abstract: BACKGROUND
  Pneumococcal pneumonia (PP) has a high burden of morbimortality in children. Use of pneumococcal conjugate vaccines (PCVs) is an effective preventive measure. After PCV 7-valent (PCV7) withdrawal, PCV 10-valent (PCV10) and PCV 13-valent (PCV13) are the alternatives in Peru. This study aimed to evaluate cost effectiveness of these vaccines in preventing PP in Peruvian children <5 years-old.
  
  
  METHODS
  A cost-effectiveness analysis was developed in three phases: a systematic evidence search for calculating effectiveness; a cost analysis for vaccine strategies and outcome management; and an economic model based on decision tree analysis, including deterministic and probabilistic sensitivity analysis using acceptability curves, tornado diagram, and Monte Carlo simulation. A hypothetic 100 vaccinated children/vaccine cohort was built. An incremental cost-effectiveness ratio (ICER) was calculated.
  
  
  RESULTS
  The isolation probability for all serotypes in each vaccine was estimated: 38% for PCV7, 41% PCV10, and 17% PCV13. Avoided hospitalization was found to be the best effectiveness model measure. Estimated costs for PCV7, PCV10, and PCV13 cohorts were USD13,761, 11,895, and 12,499, respectively. Costs per avoided hospitalization were USD718 for PCV7, USD333 for PCV10, and USD 162 for PCV13. At ICER, PCV7 was dominated by the other PCVs. Eliminating PCV7, PCV13 was more cost effective than PCV10 (confirmed in sensitivity analysis).
  
  
  CONCLUSIONS
  PCV10 and PCV13 are more cost effective than PCV7 in prevention of pneumonia in children <5 years-old in Peru. PCV13 prevents more hospitalizations and is more cost-effective than PCV10. These results should be considered when making decisions about the Peruvian National Inmunizations Schedule.
authors.affiliation: Unidad de Análisis y Generación de Evidencias en Salud Pública (UNAGESP), Centro Nacional de Salud Pública, Instituto Nacional de Salud, Lima, Peru. emezones@gmail.com.
authors.forename: Edward
authors.initials: E
authors.lastname: Mezones-Holguín
authors.forename: Rafael
authors.initials: R
authors.lastname: Bolaños-Díaz
authors.forename: Víctor
authors.initials: V
authors.lastname: Fiestas
authors.forename: César
authors.initials: C
authors.lastname: Sanabria
authors.forename: Alfonso
authors.initials: A
authors.lastname: Gutiérrez-Aguado
authors.forename: Fabián
authors.initials: F
authors.lastname: Fiestas
authors.forename: Víctor J
authors.initials: VJ
authors.lastname: Suárez
authors.forename: Alfonso J
authors.initials: AJ
authors.lastname: Rodriguez-Morales
authors.forename: Adrián V
authors.initials: AV
authors.lastname: Hernández
mesh_terms: D002675:Child, Preschool; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015233:Models, Statistical; D010568:Peru / Q000453:epidemiology; D022242:Pneumococcal Vaccines / Q000008:administration & dosage / Q000191:economics* / Q000276:immunology*; D011018:Pneumonia, Pneumococcal / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: C586648:10-valent pneumococcal conjugate vaccine; C538862:13-valent pneumococcal vaccine; D022242:Pneumococcal Vaccines