Abstract
Objective: This study estimates the cost-effectiveness of vaccination with the 13-valent pneumococcal conjugate vaccine (PCV13) among infants in Beijing, Shanghai, Shenzhen, Chengdu, Karamay, Qingdao, and Suzhou. Methods: A previously published cost-effectiveness model comparing vaccination with PCV13 to no vaccination was localized to the included Chinese cities. A systematic literature review was undertaken to identify age-specific incidence rates for pneumococcal bacteremia, pneumococcal meningitis, pneumonia, and otitis media (AOM). Age-specific direct medical costs of treating the included pneumococcal diseases were taken from the Chinese Health Insurance Association database. The base case analysis evaluated vaccine efficacy using direct effect and indirect effects (DE+ IDE). A subsequent scenario analysis evaluated the model outcomes if only DE was considered. A vaccination rate of 70% was used. The model reported outcomes over a one-year period after it was assumed the vaccine effects had reached a steady state (5–7 years after vaccine introduction) to include the direct and indirect effects of vaccination. Health outcomes were discounted at 5% during the steady-state period. Results: Vaccination with PCV13 was cost-effective in the base case analysis for all included cities with the incremental cost-effectiveness ratio (ICER) ranging from 1145 CNY(Shenzhen) to 15,422 CNY (Qingdao) per quality-adjusted life-year (QALY) gained. PCV13 was the dominant strategy in Shanghai with lower incremental costs and higher incremental QALYs. PCV13 remained cost-effective in the DE-only analysis with all ICERs falling below a cost-effectiveness threshold of three times GDP per capita in each city. Conclusions: Vaccination with PCV13 was a cost-effective strategy in the analyzed cities for both the DE-only and DE + IDE analyses. PCV13 became very cost-effective when a vaccination rate was reached where IDE is observed.
Highlights
Invasive pneumococcal diseases (IPD) caused by Streptococcus pneumoniae (S. pneumonia) include meningitis and bacteremia
PCV13 reduced the number of pneumococcal disease cases by 46.33 (Beijing), 46.30 (Shanghai), 33.92 (Chengdu), 22.91 (Shenzhen), 21.72 (Qingdao), 21.30 (Suzhou), and 1.10 (Karamay)
The reduction in pneumococcal disease cases resulted in quality-adjusted life-year (QALY) saved of 14.83 (Shanghai), 12.01 (Beijing), 9.71 (Chengdu), 7.66 (Shenzhen), 6.87 (Suzhou), 5.43 (Qingdao), and 0.27 (Karamay)
Summary
Invasive pneumococcal diseases (IPD) caused by Streptococcus pneumoniae (S. pneumonia) include meningitis and bacteremia. S. pneumonia can cause non-invasive pneumococcal infections such as pneumonia and acute otitis media (AOM). The World Health Organization (WHO) has estimated 1 million children die from pneumococcal disease each year, with the majority in developing countries [1]. The burden of pneumococcal diseases in China is significant, with an estimated 12% of global cases occurring in China [3]. In China lower respiratory infections including pneumonia were the 12th leading cause of overall deaths and premature deaths (years of life lost) in 2017 [4]. Pneumococcal diseases pose a significant burden in China where there are an estimated 30,000 deaths per year [3,5]. In 2000, it was estimated there were 22 million cases of pneumonia among children younger than five years of age in China [6]. Of patients dying of pneumonia, it is estimated that nearly 50% are attributable to S. pneumonia [7]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
