title: Do Pneumococcal Conjugate Vaccines Represent Good Value for Money in a Lower-Middle Income Country? A Cost-Utility Analysis in the Philippines.
abstract: OBJECTIVE
  The objective of this study is to assess the value for money of introducing pneumococcal conjugate vaccines as part of the immunization program in a lower-middle income country, the Philippines, which is not eligible for GAVI support and lower vaccine prices. It also includes the newest clinical evidence evaluating the efficacy of PCV10, which is lacking in other previous studies.
  
  
  METHODS
  A cost-utility analysis was conducted. A Markov simulation model was constructed to examine the costs and consequences of PCV10 and PCV13 against the current scenario of no PCV vaccination for a lifetime horizon. A health system perspective was employed to explore different funding schemes, which include universal or partial vaccination coverage subsidized by the government. Results were presented as incremental cost-effectiveness ratios (ICERs) in Philippine peso (Php) per QALY gained (1 USD = 44.20 Php). Probabilistic sensitivity analysis was performed to determine the impact of parameter uncertainty.
  
  
  RESULTS
  With universal vaccination at a cost per dose of Php 624 for PCV10 and Php 700 for PCV13, both PCVs are cost-effective compared to no vaccination given the ceiling threshold of Php 120,000 per QALY gained, yielding ICERs of Php 68,182 and Php 54,510 for PCV10 and PCV13, respectively. Partial vaccination of 25% of the birth cohort resulted in significantly higher ICER values (Php 112,640 for PCV10 and Php 84,654 for PCV13) due to loss of herd protection. The budget impact analysis reveals that universal vaccination would cost Php 3.87 billion to 4.34 billion per annual, or 1.6 to 1.8 times the budget of the current national vaccination program.
  
  
  CONCLUSIONS
  The inclusion of PCV in the national immunization program is recommended. PCV13 achieved better value for money compared to PCV10. However, the affordability and sustainability of PCV implementation over the long-term should be considered by decision makers.
authors.affiliation: National Center for Pharmaceutical Access and Management (NCPAM), Department of Health, Manila, Philippines.
authors.forename: Manuel Alexander
authors.initials: MA
authors.lastname: Haasis
authors.affiliation: National Center for Pharmaceutical Access and Management (NCPAM), Department of Health, Manila, Philippines.
authors.forename: Joyce Anne
authors.initials: JA
authors.lastname: Ceria
authors.affiliation: Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, Nonthaburi, Thailand.
authors.forename: Wantanee
authors.initials: W
authors.lastname: Kulpeng
authors.affiliation: Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, Nonthaburi, Thailand.
authors.forename: Yot
authors.initials: Y
authors.lastname: Teerawattananon
authors.affiliation: Institute of Clinical Epidemiology-National Institutes of Health (NIH), University of the Philippines, Manila, Philippines.
authors.forename: Marissa
authors.initials: M
authors.lastname: Alejandria
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D005380:Financing, Government; D006801:Humans; D017589:Immunization Programs / Q000191:economics*; D007182:Income; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D010679:Philippines; D022242:Pneumococcal Vaccines / Q000008:administration & dosage / Q000191:economics*; D011018:Pneumonia, Pneumococcal / Q000276:immunology / Q000382:microbiology / Q000517:prevention & control*; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000276:immunology; D014611:Vaccination / Q000191:economics*; D018074:Vaccines, Conjugate
chemical_list: C586648:10-valent pneumococcal conjugate vaccine; C538862:13-valent pneumococcal vaccine; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate