학술논문

How cost effective is switching universal vaccination from PCV10 to PCV13? A case study from a developing country.
Document Type
Article
Source
Vaccine. Sep2018, Vol. 36 Issue 38, p5766-5773. 8p.
Subject
*PNEUMOCOCCAL vaccines
*VACCINE effectiveness
*MEDICAL care costs
*PUBLIC health
*MEDICAL economics
Language
ISSN
0264-410X
Abstract
Highlights • Model updated with PCV10 vs. PCV13 in Colombian children after PCV10 inclusion. • Cost per YLS were examine with each alternative and in different comparisons. • Vaccination with PCV13 is the most cost-effective from the third payer perspective. • Incremental effectiveness data PCV13 vs. PCV10 are required to validate our results. Abstract Background Children immunization with pneumococcal conjugate vaccine (PCV) had profound public health effects across the globe. Colombian adopted PCV10 universal vaccination, but PCV incremental impact need to be revalued. The objective of this analysis was to estimate the cost-effectiveness of switch to PCV13 versus continue PCV10 in Colombian children. Methods A complete economic analysis was carried-out assessing potential epidemiological and economic impact of switching from PCV10 to PCV13. Epidemiological information on PCV10 impact was obtained from lab-based epidemiological surveillance on pneumococcal isolates at the Colombian National Institute of Health. Economic inputs were extracted from the literature. Incremental PCV13 effectiveness was based in additional serotypes included. Comparisons among alternatives were evaluated with the Incremental Cost-Effectiveness Ratio (ICER) at a willingness to pay of one GDP per capita (USD$ 6631) per Year of Live Saved (YLS). All costs were reported in 2014USD. Deterministic and probabilistic sensitivity analyses were performed, and 95% confidence interval reported. Results After four years using PCV10 for universal vaccination on children the Colombian health surveillance system showed a relative increment on non PCV10 isolates. To change from PCV10 to PCV13 would avoid 587 (CI95% −49–1008) ambulatory Rx community-acquired pneumoniae (CAP), 1622 (CI95% 591–2343) Inpatient RxCAP, 10 (CI 95% 6–11) pneumococcal meningitis, and 79 (CI95% 76–98) deaths. ICER per YLS was USD$ 2319 (CI95% Dominated – USD$ 4225) for Keep-PCV10 and USD$ 1771 (CI95% USD$ 1285–9884) for Switch-to PCV13. In spite of its cost-effectiveness Keep-PCV10 is an extended dominated alternative and Switch-to PCV13 would be preferred. Results are robust to parameters changes in the sensitivity analyses. Conclusion A national immunization strategy based in Switch-to PCV13 was found to be good value for money and prevent additional burden of pneumococcal disease saving additional treatment costs, when compared with to Keep-PCV10 in Colombia, however additional criteria to decision making must be taken into account. [ABSTRACT FROM AUTHOR]