Abstract
BackgroundThe GAVI Alliance supported10-valent pneumococcal conjugate vaccine (PCV10) introduction in Kenya. We estimated the cost-effectiveness of introducing either PCV10 or the13-valent vaccine (PCV13) from a societal perspective and explored the incremental impact of including indirect vaccine effects.MethodsThe costs and effects of pneumococcal vaccination among infants born in Kenya in 2010 were assessed using a decision analytic model comparing PCV10 or PCV13, in turn, with no vaccination. Direct vaccine effects were estimated as a reduction in the incidence of pneumococcal meningitis, sepsis, bacteraemic pneumonia and non-bacteraemic pneumonia. Pneumococcal disease incidence was extrapolated from a population-based hospital surveillance system in Kilifi and adjustments were made for variable access to care across Kenya. We used vaccine efficacy estimates from a trial in The Gambia and accounted for serotype distribution in Kilifi. We estimated indirect vaccine protection and serotype replacement by extrapolating from the USA. Multivariable sensitivity analysis was conducted using Monte Carlo simulation. We assumed a vaccine price of US$ 3.50 per dose.FindingsThe annual cost of delivering PCV10 was approximately US$14 million. We projected a 42.7% reduction in pneumococcal disease episodes leading to a US$1.97 million reduction in treatment costs and a 6.1% reduction in childhood mortality annually. In the base case analysis, costs per discounted DALY and per death averted by PCV10, amounted to US$ 59 (95% CI 26–103) and US$ 1,958 (95% CI 866–3,425), respectively. PCV13 introduction improved the cost-effectiveness ratios by approximately 20% and inclusion of indirect effects improved cost-effectiveness ratios by 43–56%. The break-even prices for introduction of PCV10 and PCV13 are US$ 0.41 and 0.51, respectively.ConclusionsIntroducing either PCV10 or PCV13 in Kenya is highly cost-effective from a societal perspective. Indirect effects, if they occur, would significantly improve the cost-effectiveness.
Highlights
In the year 2008, approximately 8.8 million deaths occurred worldwide in children less than five years and pneumococcal disease caused an estimated 521,000 of these deaths. [1,2] Trials of pneumococcal conjugate vaccines (PCV) conducted among infants have shown significant efficacy against invasive pneumococcal disease (IPD), [3,4,5,6] and by early 2010 PCV had been introduced into routine immunization programmes in over 50 high- and middle-income countries. [7,8] The World Health Organization had recommended the introduction of PCV into the immunization schedules in developing countries with high background rates of childhood mortality. [9]
PCV10 is currently available to Kenya at a cost of $3.50 per dose, which is being co-financed by the GAVI Alliance and the Kenyan government for a 10-year period
Working with the same assumptions, cost effectiveness of PCV10 or the13-valent vaccine (PCV13) versus status quo was US$ 47, US$ 238 and US$ 1,558 per Disability Adjusted Life Years (DALYs), case and death averted, respectively
Summary
In this economic evaluation we use Kenyan data on both treatment costs and pneumococcal disease incidence by syndrome and serotypes together with African evidence of vaccine efficacy to estimate the cost-effectiveness of delivering PCV10 in routine immunization services in Kenya. PCV10 is currently available to Kenya at a cost of $3.50 per dose, which is being co-financed by the GAVI Alliance and the Kenyan government for a 10-year period. The study may assist other countries with similar vaccine costs and pneumococcal disease patterns, and inform funding decisions of international vaccine donors. The GAVI Alliance supported10-valent pneumococcal conjugate vaccine (PCV10) introduction in Kenya. We estimated the cost-effectiveness of introducing either PCV10 or the13-valent vaccine (PCV13) from a societal perspective and explored the incremental impact of including indirect vaccine effects
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