Cost-effectiveness analysis of replacing the 10-valent pneumococcal conjugate vaccine (PCV10) with the 13-valent pneumococcal conjugate vaccine (PCV13) in Brazil infants

Johnna Perdrizet, Carlos Felipe S Santana, Thais Senna, Rodrigo Fernandes Alexandre, Rodrigo Sini de Almeida, Julia Spinardi, Matt Wasserman, Johnna Perdrizet, Carlos Felipe S Santana, Thais Senna, Rodrigo Fernandes Alexandre, Rodrigo Sini de Almeida, Julia Spinardi, Matt Wasserman

Abstract

Brazil currently has a 10-valent pneumococcal conjugate vaccine (PCV10) pediatric national immunization program (NIP). However, in recent years, there has been significant progressive increases in pneumococcal disease attributed to serotypes 3, 6A, and 19A, which are covered by the 13-valent PCV (PCV13). We sought to evaluate the cost-effectiveness and budget impact of switching from PCV10 to PCV13 for Brazilian infants from a payer perspective. A decision-analytic model was adapted to evaluate the clinical and economic outcomes of continuing PCV10 or switching to PCV13. The analysis estimated future costs ($BRL), quality-adjusted life-years (QALYs), and health outcomes for PCV10 and PCV13 over 5 y. Input parameters were from published sources. Future serotype dynamics were predicted using Brazilian and global historical trends. Over 5 y, PCV13 could prevent 12,342 bacteremia, 15,330 meningitis, 170,191 hospitalized pneumonia, and 25,872 otitis media cases, avert 13,709 pneumococcal disease deaths, gain 20,317 QALYs, and save 172 million direct costs compared with PCV10. The use of PCV13 in the Brazilian NIP could reduce pneumococcal disease, improve population health, and save substantial health-care costs. Results are reliable even when considering uncertainty for possible serotype dynamics with different underlying assumptions.

Trial registration: ClinicalTrials.gov NCT03760146.

Keywords: Brazil; PCV; Streptococcus pneumoniae; budget impact; cost-effectiveness; cost-utility analysis; economic evaluation; national immunization program; pneumococcal vaccine.

Figures

Figure 1.
Figure 1.
Base case historical invasive pneumococcal disease incidence (IPD) per 100,000 in infants 0–2 y of age in (a) 0–2 y of age, (b) 65 y or older, and (c) all ages. Data presented represent the launch of 10-valent pneumococcal conjugate vaccine (PCV10) and the historical serotype trends contained in 7-valent pneumococcal conjugate vaccine (PCV7); 1,5, and 7 F serotypes; 3, 6A, and 19A serotypes; and non-covered vaccine serotypes. Real-world data are based on the serotypes causing IPD reported annually in Brazil and incidence reported in Colombia
Figure 2.
Figure 2.
Base case invasive pneumococcal disease (IPD) serotype distribution at time of decision to switch and forecasted at 5 y with implementing either PCV10 or PCV13 on the Brazilian NIP in (a) 0 to 2 y of age, (b) 65 y of age or older, and (c) all ages. “At time of decision” indicates the “current state of pneumococcal disease considering the switch to the PCV13 strategy”
Figure 3.
Figure 3.
Base case predicted invasive pneumococcal disease incidence (IPD) based on observed real-world data per 100,000 in (a) 0–2 y of age, (b) 65 y or older, and (c) all ages. Data presented represent Historical Data for overall IPD incidence, the year 10-valent pneumococcal conjugate vaccine (PCV10) program was implement in Brazil, the current year reflecting the year the choice was made between maintaining PCV10 on the NIP or switching to PCV13, and predicted IPD for PCV10 (forecasted) and PCV13 (forecasted) depending on the choice made in the current year
Figure 4.
Figure 4.
Scenario analyses showing the predicted invasive pneumococcal disease incidence based on observed real-world data per 100,000 in children 0–2 y of age in Brazil. Scenario analyses were run where 13-valent pneumococcal conjugate vaccine (PCV13) serotype dynamics were predicted using the United Kingdom (UK), Canada (CAN), and Quebec (QC) historical trends. For reference, the base case serotype dynamics are presented for PCV13 using historical United States (US) trends and 10-valent pneumococcal conjugate vaccine (PCV10) using historical Brazil (BR) trends. Implementation of PCV10 on the Brazilian national immunization program (NIP) and schedule changes are shown

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Source: PubMed

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