title: The health and economic impact of vaccination with 7-valent pneumococcal vaccine (PCV7) during an annual influenza epidemic and influenza pandemic in China.
abstract: BACKGROUND
  China has experienced several severe outbreaks of influenza over the past century: 1918, 1957, 1968, and 2009. Influenza itself can be deadly; however, the increase in mortality during an influenza outbreak is also attributable to secondary bacterial infections, specifically pneumococcal disease. Given the history of pandemic outbreaks and the associated morbidity and mortality, we investigated the cost-effectiveness of a PCV7 vaccination program in China from the context of typical and pandemic influenza seasons.
  
  
  METHODS
  A decision-analytic model was employed to evaluate the impact of a 7-valent pneumococcal vaccine (PCV7) infant vaccination program on the incidence, mortality, and cost associated with pneumococcal disease during a typical influenza season (15% flu incidence) and influenza pandemic (30% flu incidence) in China. The model incorporated Chinese data where available and included both direct and indirect (herd) effects on the unvaccinated population, assuming a point in time following the initial introduction of the vaccine where the impact of the indirect effects has reached a steady state, approximately seven years following the implementation of the vaccine program. Pneumococcal disease incidence, mortality, and costs were evaluated over a one year time horizon. Healthcare costs were calculated using a payer perspective and included vaccination program costs and direct medical expenditures from pneumococcal disease.
  
  
  RESULTS
  The model predicted that routine PCV7 vaccination of infants in China would prevent 5,053,453 cases of pneumococcal disease and 76,714 deaths in a single year during a normal influenza season.The estimated incremental-cost-effectiveness ratios were ¥12,281 (US$1,900) per life-year saved and ¥13,737 (US$2,125) per quality-adjusted-life-year gained. During an influenza pandemic, the model estimated that routine vaccination with PCV7 would prevent 8,469,506 cases of pneumococcal disease and 707,526 deaths, and would be cost-saving.
  
  
  CONCLUSIONS
  Routine vaccination with PCV7 in China would be a cost-effective strategy at limiting the negative impact of influenza during a typical influenza season. During an influenza pandemic, the benefit of PCV7 in preventing excess pneumococcal morbidity and mortality renders a PCV7 vaccination program cost-saving.
authors.affiliation: Department of Economics, University of Michigan, 611 Tappan Street, Ann Arbor, MI, 48109, USA. rcald@uw.edu.
authors.forename: Ronald
authors.initials: R
authors.lastname: Caldwell
authors.affiliation: Health Economics and Outcomes Research, Pfizer Inc, 500 Arcola Road, Collegeville, PA, 19426, USA. Craig.Roberts@pfizer.com.
authors.forename: Craig S
authors.initials: CS
authors.lastname: Roberts
authors.affiliation: National Immunization Programme, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050, P.R. China. anzj@chinacdc.cn.
authors.forename: Zhijie
authors.initials: Z
authors.lastname: An
authors.affiliation: Health Economics and Outcomes Research, Pfizer Investment Co. Ltd, 8/F, Citic Square, 1168 Nan Jing Road (W), Shanghai, 200041, P.R. China. jechen14@gmail.com.
authors.forename: Chieh-I
authors.initials: CI
authors.lastname: Chen
authors.affiliation: Elysia Group, LLC, Xiamen Street, Alley 113, No. 17-1, Floor 2, Taipei, Taiwan. bruce.wang@elysiagroup.com.
authors.forename: Bruce
authors.initials: B
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D058872:Epidemics; D017048:Health Care Costs; D000069443:Heptavalent Pneumococcal Conjugate Vaccine / Q000191:economics* / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007251:Influenza, Human / Q000191:economics / Q000453:epidemiology / Q000276:immunology / Q000628:therapy*; D032541:Mass Vaccination / Q000191:economics; D008875:Middle Aged; D018803:Models, Economic; D058873:Pandemics; D011008:Pneumococcal Infections / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D012621:Seasons; D013296:Streptococcus pneumoniae / Q000276:immunology; D055815:Young Adult
chemical_list: D000069443:Heptavalent Pneumococcal Conjugate Vaccine