Cost-effectiveness: 10- and 13-valent pneumococcal vaccines – Argentina

Vaccine
Volume 29, Issue 31 pp. 4875-5086 (12 July 2011)
http://www.sciencedirect.com/science/journal/0264410X

Regular Papers
Cost-effectiveness analysis of the 10- and 13-valent pneumococcal conjugate vaccines in Argentina
Pages 4963-4972
Analía Urueña, Tomás Pippo, María Sol Betelu, Federico Virgilio, Norberto Giglio, Angela Gentile, Salvador García Jimenez, Bárbara Jáuregui, Andrew D. Clark, Máximo Diosque, Carla Vizzotti

Abstract
Objective
Since the 10-valent pneumococcal conjugate vaccine (PCV-10) and 13-valent pneumococcal conjugate vaccine (PCV-13) were recently licensed for use in Argentina, both vaccines were evaluated to estimate the costs, health benefits and cost-effectiveness of adding a PCV to the routine child immunization schedule.

Methodology
The integrated TRIVAC vaccine cost-effectiveness model from Pan American Health Organization’s ProVac Initiative (Version 1.0.65) was used to assess the health outcomes of 20 successive cohorts from birth to 5 years of age. PCV-10 and PCV-13 were each compared to a scenario assuming no PCV vaccination. A 3 + 1 (three doses + booster) schedule and a vaccination price of US$ 20.75 per dose was assumed in the base case for both vaccines.

Results
Introduction of PCV-13 rather than PCV-10 would increase the number of life years gained (LYG) by at least 10%. The number of LYG (and LYG after adjustment for DALY morbidity weights) was 56,882 (64,252) for PCV-10 compared to 65,038 (71,628) for PCV-13. From the health system perspective, the cost per DALY averted was US$ 8973 and US$ 10,948 for PCV-10 and PCV-13 respectively, and US$ 8546 and US$ 10,510 respectively, after incorporating costs saved by households. When PCV13 was compared to PCV10 directly, the additional benefits of PCV-13 was conferred at a cost of US$ 28,147 per DALY averted. Cost-effectiveness was influenced mainly by vaccine price, serotype replacement, pneumonia mortality and discount rate.

Conclusion
Routine vaccination against S. pneumoniae in Argentina would be cost-effective with either PCV-10 or PCV-13. PCV-13, with higher coverage of local serotypes, would prevent more cases of pneumonia, invasive pneumococcal disease, sequelae and deaths with a higher number of LYG and DALYs averted, but PCV-10, due its higher impact in the prevention of AOM, would save more costs to the healthcare system.