Abstract
BackgroundPneumococcal diseases in children under five years are common and preventable. In Colombia there are two pneumococcal conjugate vaccines (PCV) that have proved clinical efficacy. The aim was to estimate the cost-effectiveness of 13-valent PCV (PCV13) and 10-valent PCV (PCV10) in terms of prevention of Invasive Pneumococcal Diseases (IPD), radiologically-confirmed pneumonia, and their related mortality, as well as, acute otitis media (AOM) in a cohort of newborns in Colombia.MethodsWe developed an analytical decision tree model with national data including the distribution of pneumococcal serotypes in Colombia between 2009 and 2013. A simulation of vaccination of 90% of newborns in Colombia took place with a time horizon of 5 years. The analysis was done from the Colombian health system perspective. Vaccines efficacy parameters were measured as life-years gained (LYG) and avoided morbidity by pneumococcal diseases; they were determined by a systematic review of literature. A health insurance company provided the costs. A probabilistic and a univariate sensitivity analysis for epidemiological, efficacy and cost parameters were done.ResultsAfter 5 years projection, PCV13 would prevent 437 deaths due to pneumococcal infections versus 321 that would be prevented by PCV10, compared to no vaccination. PCV13 would generate 25 396 LYG, and PCV10 would generate 18 708 LYG. Medical costs avoided would be US$ 19 479 395 for PCV13 and US$ 13 703 271 for PCV10. Compared to no vaccination, PCV13 and PCV10 were cost-effective, with an incremental cost-effectiveness ratio (ICER) of US$ 489.26 and US$ 813.41 per additional LYG, respectively; besides, PCV13 was dominant over PCV10 due to lower costs and better outcomes.ConclusionPCV13 is a cost-saving strategy compared with PCV10, as part of a universal coverage vaccination program in Colombian children under one year. PCV13 is expected to lead to a greater decrement in infant mortality from pneumococcal diseases, and a higher cost saving by preventing more pneumococcal diseases compared with PCV10 in a 5 years projection.
Highlights
The diseases produced by Streptococcus Pneumoniae (SP), such as pneumonia, sepsis, meningitis and acute otitis media (AOM) are a severe public health problem
Effectiveness After 5 years follow up projection, compared to no vaccination, PCV13 would prevent 66 005 pneumococcal AOM cases and 437 deaths due to pneumococcal infections and PCV10 would prevent 31 401 pneumococcal AOM cases and 321 deaths due to pneumococcal infections
Costs the cost to vaccinate 90% of children was higher for PCV13 compared to pneumococcal conjugate vaccines (PCV) 10 (US$ 31 904 432 versus US$ 28 920 564), this price is compensated by the greater savings obtained by the avoided cases with PCV13 compared to PCV10
Summary
The diseases produced by Streptococcus Pneumoniae (SP), such as pneumonia, sepsis (including bacteremia), meningitis and acute otitis media (AOM) are a severe public health problem. In 2000 was introduced the first pneumococcal conjugated vaccine This vaccine was composed of purified capsular polysaccharides of seven pneumococcus serotypes (4, 6B, 9 V, 14, 18C, 19 F and 23 F) conjugated to a diphteria protein (CRM197), and demonstrated its clinical efficacy and effectiveness (PCV-7) [4,5,6]. Pneumococcal diseases in children under five years are common and preventable. In Colombia there are two pneumococcal conjugate vaccines (PCV) that have proved clinical efficacy. The aim was to estimate the cost-effectiveness of 13-valent PCV (PCV13) and 10-valent PCV (PCV10) in terms of prevention of Invasive Pneumococcal Diseases (IPD), radiologically-confirmed pneumonia, and their related mortality, as well as, acute otitis media (AOM) in a cohort of newborns in Colombia
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