Cost-effectiveness evaluation of the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine for children in Taiwan

Chun-Yi Lu,Nan-Chang Chiu,Ching-Hu Chung,Xu-Hao Zhang,Li-Min Huang,Eliza Kruger,Seng-Chuen Tan

doi:10.1186/s12962-020-00225-9

Abstract

BackgroundStreptococcus pneumoniae (S. pneumoniae) and non-typeable Haemophilus influenzae (NTHi) are substantial contributors to morbidity and mortality of diseases including invasive pneumococcal diseases (IPDs), pneumonia and acute otitis media (AOM) worldwide. In Taiwan, 10-valent pneumococcal polysaccharide and NTHi protein D conjugate vaccine (PHiD-CV) and 13-valent pneumococcal conjugate vaccine (PCV13) are licensed in children against pneumococcal disease. In addition to S. pneumoniae, clinical trials suggest efficacy of PHiD-CV against NTHi AOM. This study aims at evaluating the cost-effectiveness of a 2 + 1 schedule of PHiD-CV vs. PCV13 2 + 1 in the universal mass vaccination program of infants in Taiwan.MethodsA published Markov cohort model was adapted to simulate the epidemiological burden of IPD, pneumonia and AOM for a birth cohort in Taiwan over 10 years. The probability of entering a specific health state was based on the incidence rate of the diseases. Only direct medical costs were included, and costs and outcomes were discounted annually. Vaccine efficacy assumptions were based on published data and validated by a panel of independent experts. Clinical, epidemiological, and serotype distribution data were based on locally published data or the National Health Insurance Research Database. Price parity of vaccines was assumed. Published pneumococcal disease-related disutility weights were used due to lack of local data. Incremental cost-effectiveness ratio was calculated and benchmarked against the recommended threshold in Taiwan. Extensive one-way sensitivity analysis, alternative scenarios and probabilistic sensitivity analysis were performed to test the robustness of the results.ResultsPHiD-CV would potentially reduce the number of NTHi-related AOM cases substantially and prevent comparable IPD and pneumonia-related cases and deaths compared to PCV13. Over a 10-year horizon, PHiD-CV is estimated to dominate PCV13, saving 8.8 million New Taiwan Dollars (NTD) and saving 21 quality-adjusted life years. The result was robust over a wide range of sensitivity analyses. The dominance of PHiD-CV was demonstrated in 61% of the simulations.ConclusionsPHiD-CV 2 + 1 would provide comparable prevention of IPD, pneumonia cases and additional reduction of NTHi-AOM cases, and is considered dominant compared with PCV13 2 + 1 in Taiwan.

Highlights

Streptococcus pneumoniae (S. pneumoniae) and non-typeable Haemophilus influenzae (NTHi) are sub‐ stantial contributors to morbidity and mortality of diseases including invasive pneumococcal diseases (IPDs), pneu‐ monia and acute otitis media (AOM) worldwide
The prevalence of NTHi infections has increased, while at the same time H. influenzae type b disease has relatively decreased with the introduction of routine immunization of children, IPDs affect people of all ages, with the greatest burden of disease among young children and older adults, the incidence varies country-to-country and over time
There was a progressive reduction in the number of patients with AOM caused by the S. pneumoniae bacterium, which might be due to a couple of reasons such as antibiotics prescription changes and vaccination [9]

Summary

Introduction

Streptococcus pneumoniae (S. pneumoniae) and non-typeable Haemophilus influenzae (NTHi) are sub‐ stantial contributors to morbidity and mortality of diseases including invasive pneumococcal diseases (IPDs), pneu‐ monia and acute otitis media (AOM) worldwide. The prevalence of NTHi infections has increased, while at the same time H. influenzae type b disease has relatively decreased with the introduction of routine immunization of children, IPDs affect people of all ages, with the greatest burden of disease among young children and older adults, the incidence varies country-to-country and over time. A retrospective study of paediatric patients with culture-proven AOM in a hospital in Taiwan found that between 1999 and 2008 the most commonly isolated pathogens were S. pneumoniae (68%) followed by NTHi (19%) [9]. There was a progressive reduction in the number of patients with AOM caused by the S. pneumoniae bacterium, which might be due to a couple of reasons such as antibiotics prescription changes and vaccination [9]

Objectives

Methods

Conclusion