title: Cost-effectiveness of 13-valent pneumococcal conjugate vaccination in Mongolia.
abstract: The Ministry of Health (MOH), Mongolia, is considering introducing 13-valent pneumococcal conjugate vaccine (PCV13) in its national immunization programme to prevent the burden of disease caused by Streptococcus pneumoniae. This study evaluates the cost-effectiveness and budget impact of introducing PCV13 compared to no PCV vaccination in Mongolia.
  
  
  
  The incremental cost-effectiveness ratio (ICER) of introducing PCV13 compared to no PCV vaccination was assessed using an age-stratified static multiple cohort model. The risk of various clinical presentations of pneumococcal disease (meningitis, pneumonia, non-meningitis non-pneumonia invasive pneumococcal disease and acute otitis media) at all ages for thirty birth cohorts was assessed. The analysis considered both health system and societal perspectives. A 3+0 vaccine schedule and price of US$3.30 per dose was assumed for the baseline scenario based on Gavi, the Vaccine Alliance's advance market commitment tail price.
  
  
  
  The ICER of PCV13 introduction is estimated at US$52 per disability-adjusted life year (DALY) averted (health system perspective), and cost-saving (societal perspective). Although indirect effects of PCV have been well-documented, a conservative scenario that does not consider indirect effects estimated PCV13 introduction to cost US$79 per DALY averted (health system perspective), and US$19 per DALY averted (societal perspective). Vaccination with PCV13 is expected to cost around US$920,000 in 2016, and thereafter US$820,000 every year. The programme is likely to reduce direct disease-related costs to MOH by US$440,000 in the first year, increasing to US$510,000 by 2025.
  
  
  
  Introducing PCV13 as part of Mongolia's national programme appears to be highly cost-effective when compared to no vaccination and cost-saving from a societal perspective at vaccine purchase prices offered through Gavi. Notwithstanding uncertainties around some parameters, cost-effectiveness of PCV introduction for Mongolia remains robust over a range of conservative scenarios. Availability of high-quality national data would improve future economic analyses for vaccine introduction.
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore 117549, Singapore. Electronic address: neisha_sundaram@nuhs.edu.sg.
authors.forename: Neisha
authors.initials: N
authors.lastname: Sundaram
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore 117549, Singapore. Electronic address: ephchc@nus.edu.sg.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Chen
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore 117549, Singapore. Electronic address: joanne_yoong@nuhs.edu.sg.
authors.forename: Joanne
authors.initials: J
authors.lastname: Yoong
authors.affiliation: Mongolian National University of Medical Sciences, S. Zorig St-3, P.O. Box 48/111, Ulaanbaatar 14210, Mongolia. Electronic address: munkherdene@mnums.edu.mn.
authors.forename: Munkh-Erdene
authors.initials: ME
authors.lastname: Luvsan
authors.affiliation: Expanded Programme on Immunization, World Health Organization Regional Office for the Western Pacific, United Nations Ave Corner Taft Ave, Manila 1000, Philippines. Electronic address: kaf6@cdc.gov.
authors.forename: Kimberley
authors.initials: K
authors.lastname: Fox
authors.affiliation: Ministry of Health and Sports, Government Building VIII, Olympic Street 2, Sukhbaatar District, Ulaanbaatar 14210, Mongolia. Electronic address: amarzaya@moh.gov.mn.
authors.forename: Amarzaya
authors.initials: A
authors.lastname: Sarankhuu
authors.affiliation: Pneumococcal and International Child Health Research Groups, Murdoch Childrens Research Institute, Royal Children's Hospital, Flemington Road, Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Flemington Road, Parkville, VIC, Australia. Electronic address: sophie.lavincente@rch.org.au.
authors.forename: Sophie
authors.initials: S
authors.lastname: La Vincente
authors.affiliation: Modelling and Economics Unit, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom. Electronic address: mark.jit@lshtm.ac.uk.
authors.forename: Mark
authors.initials: M
authors.lastname: Jit
mesh_terms: D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D017589:Immunization Programs; D007115:Immunization Schedule; D007223:Infant; D008297:Male; D032541:Mass Vaccination / Q000191:economics*; D015233:Models, Statistical; D008986:Mongolia; D011008:Pneumococcal Infections / Q000191:economics* / Q000276:immunology / Q000382:microbiology / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000008:administration & dosage / Q000191:economics*; D019057:Quality-Adjusted Life Years; D013296:Streptococcus pneumoniae / Q000276:immunology* / Q000472:pathogenicity; D018074:Vaccines, Conjugate
chemical_list: C538862:13-valent pneumococcal vaccine; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate
keywords: Budget impact; Cost-effectiveness; Mongolia; PCV13; Pneumococcal conjugate vaccine; Vaccine