Purpose: To determine the effectiveness and cost-effectiveness of pediatric pneumococcal conjugate vaccine (PCV) program options, highlighting potential qualitative differences in valuing health outcomes.
Method: Streptococcus pneumoniae and nontypable Haemophilus influenzae (NTHi) infections cause substantial childhood disease: approximately 150 cases of invasive pneumococcal disease (IPD) and >150,000 cases of non-invasive disease (NID) annually in 2.2 million Ontario children <15 years. We developed a decision-analytic model to determine the effectiveness and cost-effectiveness of a 13-valent (PCV13) vaccine compared to a 10-valent (PCV10) vaccine. These protect against 13 and 10 S. pneumoniae serotypes, respectively. PCV10 may also protect against NTHi acute otitis media. Compared to PCV13, PCV10 use might result in smaller quality-adjusted life year (QALY) gains from preventing serious IPD, but in greater total QALY gains. We therefore examined three scenarios: 1) IPD only; 2) IPD and NID due to S. pneumoniae; and 3) IPD and NID due to S. pneumonia and NTHi. We estimated QALYs and costs during one year for children <15 years, assuming a steady-state situation. Parameter values were from laboratory surveillance data, health administrative data, and the literature. We based our vaccine price estimates on published Canadian PCV prices and allowed for bulk buying discounts, as procured vaccine prices are not publicly available.
Results: For IPD alone, PCV13 is more effective (62 QALYs gained) and more costly (C$3.5 Million) than PCV10, but cost-effective in the deterministic analysis (ICER <$120,000/QALY gained). For invasive and non-invasive S. pneumonia disease, PCV13 has the greatest benefit (188 QALYs gained) and is cost saving. However, the probability of PCV13 being cost-effective is low for both scenarios (<0.30), reflecting the high uncertainty of NID data. For all NID and IPD, the incremental benefit of PCV13 decreases to 31 QALYs gained, and it is no longer cost-effective. Sensitivity analysis confirmed the importance of both the underlying epidemiology and the price of PCV13 relative to PCV10. PCV13 is likely to be cost-effective if the vaccine price does not exceed the cost of PCV10 by more than C$3.
Conclusion: If valuing QALYs gained from invasive and non-invasive disease equally, PCV13 is likely to be cost-effective if the absolute price differential is small. However, due to the high level of uncertainty, further research to better describe the epidemiology of non-invasive disease is needed.
See more of: The 33rd Annual Meeting of the Society for Medical Decision Making