Pharmacoeconomic aspects of vaccination against Pneumococcal Infection in Russia

Abstract

Pneumococcal infection prevention in children of the first 5 years of life in Russia is of high importance due to high morbidity and mortality. The goal of the study is pharmacoeconomic assessment of first year of life infants vaccination program by 13-valent conjugate pneumococcal vaccine (PCV13) for both routine vaccination by 3 doses and for selected vaccination of premature (born before 32 week of pregnancy) children by 4 doses. Modeling based on clinical trials and epidemiology data results has been established. The costs of Medical care have been obtained from the 2011 State Insurance tariff in St.Petersburg. Analysis has been done from the position of the Health Care system (only direct medical costs) and from the social perspective (analysis of direct medical and indirect costs) with 10 and 20 years horizon and for the full length of life. In routine vaccination scenario and in case of investing to the Health Care system for 10 years cost effectiveness of PCV13 in general population of children including herd effect is 44,2K rubles/1 additional life year gained for direct medical costs only. In direct and indirect costs estimating vaccination is dominating – so, not only decreasing the incidence and morbidity but cost-saving for 2,1K rubles per patient. Study horizon extension (prolongation of the period when the State is ready to wait for the return of investment) is leading to the vaccination cost-effectiveness increase: without herd effect the cost/effectiveness is 505,1K rubles per 1 additional life year gained in 10 years horizon and 100,6K rubles in analysis for the full length of life. Selected vaccination of premature children is also cost effective as these children are at real high risk for Pneumococcal Infection – efficiency in 10 years horizon for direct medical costs is 131,2K rubles per 1 additional life year gained and for indirect and direct costs is 48,3K rubles per 1 additional life year gained. But it is important to mention that routine vaccination of all children during the first year of life is more efficient due to herd effect starting from the third year of the routine immunization start. According to the WHO recommendations efficiency of medical interventions can be assessed by comparison with the NDP – in Russia in 2012 this has been 316K rubles per citizen. Therefore, PCV13 can be recommended for inclusion and addition to the Russian National Immunization Calendar due to the high clinical effectiveness with appropriate cost-effectiveness even its’ implementation needs significant increase of budget investment to vaccination. Routine vaccination is economically more preferable and efficient in comparison to selected groups’ vaccination and will provide the return of investment and budget cost savings in 10 years period from the start.