title: Modeling the cost-effectiveness of infant vaccination with pneumococcal conjugate vaccines in Germany.
abstract: BACKGROUND
  In 2009, the European Medicines Agency granted approval for two higher-valent pneumococcal conjugate vaccines. This study aims to evaluate the cost-effectiveness of universal infant (<2 years old) vaccination with a 13-valent pneumococcal conjugate vaccine (PCV13) in comparison with a 10-valent pneumococcal conjugate vaccine (PCV10) for the prevention of pneumococcal disease in Germany.
  
  
  METHODS
  A population-based Markov model was developed to estimate the impact of PCV13 and PCV10 on invasive pneumococcal disease (IPD), non-invasive pneumonia (PNE), and acute otitis media (AOM) over a time horizon of 50 years. The model included the effects of the historical vaccination scheme in infants as well as indirect herd effects and replacement disease. We used German epidemiological data to calculate episodes of IPD, PNE, and AOM, as well as direct and indirect effects of the vaccination. Parameter uncertainty was tested in univariate and probabilistic sensitivity analyses.
  
  
  RESULTS
  In the base-case analysis, the ICER of PCV13 versus PCV10 infant vaccination was EUR 9826 per quality-adjusted life-year (QALY) gained or EUR 5490 per life-year (LY) gained from the societal perspective and EUR 3368 per QALY gained or EUR 1882 per LY gained from the perspective of the German statutory health insurance. The results were particularly sensitive to the magnitude of indirect effects of both vaccines.
  
  
  CONCLUSIONS
  Universal infant vaccination with PCV13 is likely to be a cost-effective intervention compared with PCV10 within the German health care system, if additional net indirect effects of PCV13 vaccination are significant.
authors.affiliation: Center for Health Economics Research Hannover (CHERH), Leibniz Universität Hannover, Otto-Brenner-Straße 1, 30159, Hanover, Germany. ak@ivbl.uni-hannover.de.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kuhlmann
authors.affiliation: Center for Health Economics Research Hannover (CHERH), Leibniz Universität Hannover, Otto-Brenner-Straße 1, 30159, Hanover, Germany.
authors.forename: J-Matthias Graf
authors.initials: JG
authors.lastname: von der Schulenburg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005858:Germany; D006801:Humans; D032521:Immunity, Herd; D007223:Infant; D007231:Infant, Newborn; D008390:Markov Chains; D008581:Meningitis / Q000191:economics / Q000517:prevention & control; D008875:Middle Aged; D015233:Models, Statistical; D010033:Otitis Media / Q000191:economics / Q000517:prevention & control; D011008:Pneumococcal Infections / Q000191:economics* / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage* / Q000191:economics*; D011014:Pneumonia / Q000191:economics / Q000517:prevention & control; D019057:Quality-Adjusted Life Years; D055815:Young Adult
chemical_list: C586648:10-valent pneumococcal conjugate vaccine; C538862:13-valent pneumococcal vaccine; D022242:Pneumococcal Vaccines
keywords: Cost-effectiveness; Costs; Economic evaluation; Herd protection; Pneumococcal conjugate vaccine; Vaccination