title: Cost-effectiveness analysis of infant universal routine pneumococcal vaccination in Malaysia and Hong Kong.
abstract: Pneumococcal disease causes large morbidity, mortality and health care utilization and medical and non-medical costs, which can all be reduced by effective infant universal routine immunization programs with pneumococcal conjugate vaccines (PCV). We evaluated the clinical and economic benefits of such programs with either 10- or 13-valent PCVs in Malaysia and Hong Kong by using an age-stratified Markov cohort model with many country-specific inputs. The incremental cost per quality-adjusted life year (QALY) was calculated to compare PCV10 or PCV13 against no vaccination and PCV13 against PCV10 over a 10-year birth cohort's vaccination. Both payer and societal perspectives were used. PCV13 had better public health and economic outcomes than a PCV10 program across all scenarios considered. For example, in the base case scenario in Malaysia, PCV13 would reduce more cases of IPD (+2,296), pneumonia (+705,281), and acute otitis media (+376,967) and save more lives (+6,122) than PCV10. Similarly, in Hong Kong, PCV13 would reduce more cases of IPD cases (+529), pneumonia (+172,185), and acute otitis media (+37,727) and save more lives (+2,688) than PCV10. During the same time horizon, PCV13 would gain over 74,000 and 21,600 additional QALYs than PCV10 in Malaysia and Hong Kong, respectively. PCV13 would be cost saving when compared against similar program with PCV10, under both payer and societal perspective in both countries. PCV13 remained a better choice over PCV10 in multiple sensitivity, scenario, and probabilistic analyses. PCV13s broader serotype coverage in its formulation and herd effect compared against PCV10 were important drivers of differences in outcomes.
authors.affiliation: a School of Pharmacy; Monash University Malaysia ; Bandar Sunway , Malaysia.
authors.forename: David Bin-Chia
authors.initials: DB
authors.lastname: Wu
authors.affiliation: b Pfizer Inc. ; Collegeville , PA USA.
authors.forename: Craig
authors.initials: C
authors.lastname: Roberts
authors.affiliation: c School of Pharmacy; The Chinese University of Hong Kong ; Hong Kong , China.
authors.forename: Vivian Wing Yan
authors.initials: VW
authors.lastname: Lee
authors.affiliation: d Pfizer (Malaysia) Sdn Bhd ; Bandar Sunway , Malaysia.
authors.forename: Li-Wen
authors.initials: LW
authors.lastname: Hong
authors.affiliation: e Department of Pediatrics ; Hospital Tuanku Jaafar ; Seramban , Negeri Sembilan , Malaysia.
authors.forename: Kah Kee
authors.initials: KK
authors.lastname: Tan
authors.affiliation: a School of Pharmacy; Monash University Malaysia ; Bandar Sunway , Malaysia.
authors.forename: Vivienne
authors.initials: V
authors.lastname: Mak
authors.affiliation: a School of Pharmacy; Monash University Malaysia ; Bandar Sunway , Malaysia.
authors.forename: Kenneth Kwing Chin
authors.initials: KK
authors.lastname: Lee
mesh_terms: D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D006723:Hong Kong; D006801:Humans; D032521:Immunity, Herd / Q000276:immunology; D017589:Immunization Programs / Q000191:economics*; D007223:Infant; D008296:Malaysia; D011008:Pneumococcal Infections / Q000191:economics* / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000276:immunology; D014611:Vaccination / Q000191:economics*; D018074:Vaccines, Conjugate / Q000276:immunology
chemical_list: C586648:10-valent pneumococcal conjugate vaccine; C538862:13-valent pneumococcal vaccine; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate
keywords: 10-valent pneumococcal conjugate vaccine (PCV10); 13-valent pneumococcal conjugate vaccine (PCV13); Markov transition-state model; herd effect; incremental cost-effectiveness ratio (ICER); pneumococcal disease