title: Cost-effectiveness and Health Benefits of Pediatric 23-valent Pneumococcal Polysaccharide Vaccine, 7-valent Pneumococcal Conjugate Vaccine and Forecasting 13-valent Pneumococcal Conjugate Vaccine in China.
abstract: Each year in China, approximately 700,000 children under 5 years old are diagnosed with pneumonia, and 30,000 die of the disease. Although 7-valent pneumococcal conjugate vaccine (PCV-7) and 23-valent pneumococcal polysaccharide vaccine (PPV-23) are available in China, the costs are borne by the consumer, resulting in low coverage for PCV-7. We aimed to conduct a simulation study to assess the cost-effectiveness and health benefits of PCV-7, 13-valent pneumococcal conjugate vaccine (PCV-13) and PPV-23 to prevent childhood pneumonia and other vaccine-preventive diseases in China.
  
  
  
  An economic evaluation was performed using a Markov simulation model. Parameters including demographic, epidemiological data, costs and efficacy of vaccines were obtained from previous studies. A hypothetical cohort of 100,000 newborns (focusing on pneumococcal diseases ≤7 years old) was followed up until death or 100 years of age. The model incorporated the impact of vaccination on reduction of incidence of pneumococcal diseases and mortality of children ≤7 years. Outcomes are presented in terms of disease cases averted, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio.
  
  
  
  Under baseline assumptions, PPV-23 is currently the only cost-effective option, whereas PCV-13 showed the greatest impact on pneumococcal disease burden, reducing invasive pneumococcal diseases by 31.3%, pneumonia by 15.3% and gaining 73.8 QALYs (10,000 individuals at discount rate of 3%). Incremental cost-effectiveness ratios of PCV-13 and PCV-7 are US$29,460/QALY and US$104,094/QALY, respectively, showing no cost-effectiveness based on the World Health Organization recommended willingness-to-pay threshold. On the other hand, the incremental cost-effectiveness ratios of PCVs were most sensitive to vaccination costs; if it reduces 4.7% and 32.2% for PCV-7 and PCV-13, respectively, the vaccination will be cost-effective.
  
  
  
  To scale up current vaccination strategies and achieve potential health benefits, the replacement of PCV-7 with PCV-13 should be considered. As well, PCV's costs need to be reduced by increasing public subsidies and providing financial support to poor families.
authors.affiliation: From the *School of Public Health, Shandong University, Jinan, China; †Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan; ‡Qilu Hospital of Shandong University, Jinan, China.
authors.forename: Xiuting
authors.initials: X
authors.lastname: Mo
authors.forename: Ruoyan
authors.initials: R
authors.lastname: Gai Tobe
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Liu
authors.forename: Rintaro
authors.initials: R
authors.lastname: Mori
mesh_terms: D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008390:Markov Chains; D018803:Models, Economic; D011008:Pneumococcal Infections / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000191:economics*
chemical_list: D022242:Pneumococcal Vaccines