Cost-effectiveness analysis of a universal mass vaccination program with a PHiD-CV 2+1 schedule in Malaysia

Xiao Jun Wang,Ashwini Saha,Xu-Hao Zhang

doi:10.1186/s12962-017-0079-2

Abstract

BackgroundCurrently, two pediatric pneumococcal conjugate vaccines are available in the private market of Malaysia—13-valent pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide and non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV). This study aimed to evaluate the cost-effectiveness of a universal mass vaccination program with a PHiD-CV 2+1 schedule versus no vaccination or with a PCV13 2+1 schedule in Malaysia.MethodsA published Markov cohort model was adapted to evaluate the epidemiological and economic consequences of programs with no vaccination, a PHiD-CV 2+1 schedule or a PCV13 2+1 schedule over a 10-year time horizon. Disease cases, deaths, direct medical costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were estimated. Locally published epidemiology and cost data were used whenever possible. Vaccine effectiveness and disutility data were based on the best available published data. All data inputs and assumptions were validated by local clinical and health economics experts. Analyses were conducted from the perspective of the Malaysian government for a birth cohort of 508,774. Costs and QALYs were discounted at 3% per annum. One-way and probabilistic sensitivity analyses were performed.ResultsCompared with no vaccination, a PHiD-CV 2+1 program was projected to prevent 1109 invasive pneumococcal disease (IPD), 24,679 pneumonia and 72,940 acute otitis media (AOM) cases and 103 IPD/pneumonia deaths over 10 years, with additional costs and QALYs of United States dollars (USD) 30.9 million and 1084 QALYs, respectively, at an ICER of USD 28,497/QALY. Compared with a PCV13 2+1 program, PHiD-CV 2+1 was projected to result in similar reductions in IPD cases (40 cases more) but significantly fewer AOM cases (30,001 cases less), with cost savings and additional QALYs gained of USD 5.2 million and 116 QALYs, respectively, demonstrating dominance over PCV13. Results were robust to variations in one-way and probabilistic sensitivity analyses.ConclusionsA PHiD-CV 2+1 universal mass vaccination program could substantially reduce pneumococcal disease burden versus no vaccination, and was expected to be cost-effective in Malaysia. A PHiD-CV 2+1 program was also expected to be a dominant choice over a PCV13 2+1 program in Malaysia.

Highlights

Two pediatric pneumococcal conjugate vaccines are available in the private market of Malaysia—13-valent pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide and non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV)
Unlike Aljunid et al [10], Wu et al [11] did not account for the protective effects of PHiD-CV in a number of key areas: (1) cross-protection against serotypes 6A and 19A, which has been demonstrated in a number of recent studies [12,13,14]; (2) indirect protection against invasive pneumo‐ coccal disease (IPD), which has been shown in surveillance data from Finland [15] and New Zealand [16]; and (3) protection against non-typeable Haemophilus influenzae (NTHi) acute otitis media (AOM), which has been shown in both the randomized controlled Clinical Otitis Media and Pneumonia Study (COMPAS) study [17] and the randomized controlled Pneumococcal Otitis Efficacy Trial (POET) study of PHiD-CV’s 11-valent precursor [18]
Cost‐effectiveness analysis PHiD‐CV 2+1 versus no vaccination It was projected that vaccination with a PHiD-CV 2+1 program would prevent 1109 cases of IPD, 24,679 cases of all-cause pneumonia, 72,940 cases of AOM and 103 IPD/pneumonia deaths compared with no vaccination strategy for the birth cohort of 508,774 in Malaysia over 10 years (Table 5)

Summary

Introduction

Two pediatric pneumococcal conjugate vaccines are available in the private market of Malaysia—13-valent pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide and non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV). Pneumococcal conjugate vaccines (PCVs) were recommended as a priority for inclusion in national childhood immunization programs in all countries by the WHO in 2007 [9] They are not currently included in the national immunization program in Malaysia, two PCVs are available in the private market of Malaysia: a 13-valent pneumococcal conjugate vaccine (PCV13; Prevenar 13) and a pneumococcal polysaccharide and NTHi protein D conjugate vaccine (PHiD-CV; Synflorix). It is necessary to conduct another cost-effectiveness analysis, taking into account the latest evidence of vaccine effectiveness

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