Abstract
SummaryBackgroundIntroduction of pneumococcal conjugate vaccines (PCVs) has substantially reduced disease burden due to Streptococcus pneumoniae, a leading cause of childhood morbidity and mortality globally. However, PCVs are among the most expensive vaccines, hindering their introduction in some settings and threatening sustainability in others. We aimed to assess the effect and cost-effectiveness of introduction of 13-valent PCV (PCV13) vaccination globally.MethodsWe assessed the incremental cost-effectiveness ratio of PCV13 introduction by integrating two models: an ecological model (a parsimonious, mechanistic model validated with data from post-seven-valent PCV introduction in 13 high-income settings) to predict the effect of PCV on childhood invasive pneumococcal disease, and a decision-tree model to predict a range of clinical presentations and economic outcomes under vaccination and no-vaccination strategies. The models followed 30 birth cohorts up to age 5 years in 180 countries from 2015 to 2045. One-way scenario and probabilistic sensitivity analyses were done to explore model uncertainties.FindingsWe estimate that global PCV13 use could prevent 0·399 million child deaths (95% credible interval 0·208 million to 0·711 million) and 54·6 million disease episodes (51·8 million to 58·1 million) annually. Global vaccine costs (in 2015 international dollars) of $15·5 billion could be partially offset by health-care savings of $3·19 billion (2·62 billion to 3·92 billion) and societal cost savings of $2·64 billion (2·13 billion to 3·28 billion). PCV13 use is probably cost-effective in all six UN regions. The 71 countries eligible for support from Gavi, the Vaccine Alliance, account for 83% of PCV13-preventable deaths but only 18% of global vaccination costs. The expected cost of PCV vaccination globally is around $16 billion per year.InterpretationOur findings highlight the value of Gavi's support for PCV introduction in low-income countries and of efforts to improve the affordability of PCVs in countries not eligible for, or transitioning from, Gavi support.FundingWorld Health Organization; Gavi, the Vaccine Alliance; and the Bill & Melinda Gates Foundation.
Highlights
Pneumonia is the single largest global cause of mortality from infectious disease in children younger than 5 years.[1]
Existing studies either omit many of the effects of pneumococcal conjugate vaccines (PCVs) intro duction, such as herd protection and serotype replace ment, or address only a subset of countries.[9,10]. To address this evidence gap, we evaluated the costeffectiveness of introducing PCV13 vaccination globally, accounting for regional pneumococcal epidemiology and using post-vaccination data from countries that have introduced PCVs
We examined articles identified in two reviews of pneumococcal conjugate vaccine (PCV) cost-effectiveness
Summary
Pneumonia is the single largest global cause of mortality from infectious disease in children younger than 5 years.[1]. Immunisation is the most effective means of prevention, and introduction of H influenzae type b vaccination in almost all countries has led to sharp reductions in H influenzae-attributable pneumonia over the past decade.[5] Two pneumococcal conjugate vaccines (PCVs), ten-valent PCV (PCV10) and 13-valent PCV (PCV13), are used in children. These PCVs have been widely adopted in high-income countries and have been introduced in low-income countries with the support of Gavi, the Vaccine Alliance. Enumerating the potential benefits, long-term budget implications, and cost-effectiveness of PCVs is crucial to sustain funding for these vaccines in countries that have introduced them, and to assess their introduction in other countries
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