Abstract
ObjectiveThe Ministry of Health (MOH), Mongolia, is considering introducing 13-valent pneumococcal conjugate vaccine (PCV13) in its national immunization programme to prevent the burden of disease caused by Streptococcus pneumoniae. This study evaluates the cost-effectiveness and budget impact of introducing PCV13 compared to no PCV vaccination in Mongolia. MethodsThe incremental cost-effectiveness ratio (ICER) of introducing PCV13 compared to no PCV vaccination was assessed using an age-stratified static multiple cohort model. The risk of various clinical presentations of pneumococcal disease (meningitis, pneumonia, non-meningitis non-pneumonia invasive pneumococcal disease and acute otitis media) at all ages for thirty birth cohorts was assessed. The analysis considered both health system and societal perspectives. A 3+0 vaccine schedule and price of US$3.30 per dose was assumed for the baseline scenario based on Gavi, the Vaccine Alliance’s advance market commitment tail price. ResultsThe ICER of PCV13 introduction is estimated at US$52 per disability-adjusted life year (DALY) averted (health system perspective), and cost-saving (societal perspective). Although indirect effects of PCV have been well-documented, a conservative scenario that does not consider indirect effects estimated PCV13 introduction to cost US$79 per DALY averted (health system perspective), and US$19 per DALY averted (societal perspective). Vaccination with PCV13 is expected to cost around US$920,000 in 2016, and thereafter US$820,000 every year. The programme is likely to reduce direct disease-related costs to MOH by US$440,000 in the first year, increasing to US$510,000 by 2025. ConclusionIntroducing PCV13 as part of Mongolia’s national programme appears to be highly cost-effective when compared to no vaccination and cost-saving from a societal perspective at vaccine purchase prices offered through Gavi. Notwithstanding uncertainties around some parameters, cost-effectiveness of PCV introduction for Mongolia remains robust over a range of conservative scenarios. Availability of high-quality national data would improve future economic analyses for vaccine introduction.
Highlights
Streptococcus pneumoniae caused an estimated 500,000 deaths worldwide among children under five years of age in 2008 [1]
The incremental cost-effectiveness ratio (ICER) per disability-adjusted life year (DALY) averted from PCV13 introduction in Mongolia is estimated to be $52 from a health system perspective, and cost-saving from a societal perspective (Table 3)
The most pessimistic scenario was purchase of PCV13 at the higher Pan American Health Organization (PAHO) price, which cost $460 and $390 per DALY averted from health system and societal perspectives, respectively ($540 and $480, respectively, when considering the unlikely but further conservative case of population direct effects only from vaccine)
Summary
Streptococcus pneumoniae caused an estimated 500,000 deaths worldwide among children under five years of age in 2008 [1]. In Mongolia, pneumonia is a leading cause of childhood mortality, as well as accounting for 51% of all-age respiratory disease admissions [2]. Especially in winter, exacerbates the problems caused by pneumonia and other acute respiratory infections [3]. S. pneumoniae and Haemophilus influenzae type b (Hib) are leading causes of childhood pneumonia-related deaths [5] and cause a substantial portion of meningitis and sepsis, in the absence of vaccination. Since introduction of Hib vaccine in 2005 in Mongolia [6], the continuing high rate of childhood pneumonia is attributable to pneumococcus more than any other single cause
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