Pneumococcal Vaccination for Children in Asian Countries: A Systematic Review of Economic Evaluation Studies.

Neily Zakiyah,Auliya A Suwantika,Jurjen Van Der Schans,Maarten J Postma,Widya N Insani

doi:10.3390/vaccines8030426

Abstract

Background: Evidence on costs and health benefits of pneumococcal conjugate vaccine (PCV) for children in Asian countries is limited but growing. As a region with a considerably high burden of pneumococcal disease, it is prominent to have a comprehensive overview on the cost-effectiveness of implementing and adopting a PCV vaccination program. Methods: We conducted a systematic review from Pubmed and Embase to identify economic evaluation studies of PCV for children in Asian countries up to May 2020. Data extraction included specific characteristics of the study, input parameters, cost elements, cost-effectiveness results, and key drivers of uncertainty. The Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) statement was followed for this systematic review. The reporting quality of the included studies was evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. Results: After the screening process on both the title and abstract and full text of 518 records, a total of 25 studies fulfilled the inclusion criteria, and were included in the review. The majority of included studies demonstrates that PCV for children is cost-effective in most of the Asian region, and even cost-saving in some countries. Most of the included studies implemented cost utility analysis (CUA) using either quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs). Overall, the main drivers affecting the cost effectiveness were vaccine price, burden regarding pneumonia-related parameters, and the inclusion of herd effects. Conclusion: The children pneumococcal vaccination program appears to be a cost-effective intervention in Asia, and even cost-saving in certain conditions. Vaccine price, pneumonia-related disease burden, and the inclusion of the herd effect are observed as important key drivers in estimating cost-effectiveness in this region. Incorporating PCV in vaccination programs in this region was found to be highly favorable.

Highlights

Pneumococcal disease (PD), which is caused by Streptococcus pneumoniae (SP), remains to be a globally problematic burden, accounting for 16% of deaths in children less than five years of age [1,2].SP is transmitted through the exposure to airborne droplets, when there is direct individual-to-individual contact
Considering the high burden of PD in Asia and the lack of a comprehensive review on a health-economic evaluation of pneumococcal conjugate vaccine (PCV) in this region, we aimed to summarize potential health and economic benefits of PCV for children in Asian countries
The screening process was performed by two reviewers (NZ and WNI) with the following inclusion criteria: Study design should be a complete economic evaluation classified in one of the formal health-economic study categories, including cost-minimization analysis (CMA), cost-effectiveness analysis (CEA), cost-utility analysis (CUA), or cost-benefit analysis (CBA); and the intervention should be a universal PCV immunization program for children in Asian countries

Summary

Introduction

Pneumococcal disease (PD), which is caused by Streptococcus pneumoniae (SP), remains to be a globally problematic burden, accounting for 16% of deaths in children less than five years of age [1,2].SP is transmitted through the exposure to airborne droplets, when there is direct individual-to-individual contact. Pneumococcal disease (PD), which is caused by Streptococcus pneumoniae (SP), remains to be a globally problematic burden, accounting for 16% of deaths in children less than five years of age [1,2]. Evidence on costs and health benefits of pneumococcal conjugate vaccine (PCV) for children in Asian countries is limited but growing. As a region with a considerably high burden of pneumococcal disease, it is prominent to have a comprehensive overview on the cost-effectiveness of implementing and adopting a PCV vaccination program. Methods: We conducted a systematic review from Pubmed and Embase to identify economic evaluation studies of PCV for children in Asian countries up to May 2020. The majority of included studies demonstrates that PCV for children is cost-effective in most of the Asian region, and even cost-saving in some countries. Conclusion: The children pneumococcal vaccination program appears to be a cost-effective intervention in Asia, and even cost-saving in certain conditions

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Conclusion