Economic evaluation of the second generation pneumococcal conjugate vaccine in children : a systematic review

Abstract

Background Pneumococcal disease, caused by Streptococcus pneumoniae (S. pneumoniae), leads to a great burden of morbidity and mortality globally, especially in developing countries. World Health Organization (WHO) estimated that 476,000 out of 8.8 million global annual deaths in children under 5 years old in 2008 were due to pneumococcal infection. Currently there are 2 second generation pneumococcal conjugate vaccines (PCVs) targeted at children, the 10-valent pneumococcal conjugate vaccine (PCV-10) and 13-valent pneumococcal conjugate vaccine (PCV-13) available in the market for the prevention of pneumococcal disease. Nowadays, about half of the countries already included PCVs into their National Immunization Programme (NIP) and around one-fourth are planning the introduction. The objective of this systematic review is to evaluate the cost-effectiveness of PCV-10 and PCV-13 so that the results could inform policy decisions of including PCVs into the NIP.

Methods A systematic review was conducted by searching from 2 databases (PubMed and Medline) for the economic evaluation studies of the PCV-10 and PCV-13. Information of the design and characteristics of studies, burden of pneumococcal disease assumption, and baseline vaccine efficacy assumptions were extracted and results were presented in incremental cost-effectiveness ratio (ICER).

Results Eleven studies were included, with 4 studies done in Europe, 3 in South America, 2 in Africa, 1 in Asia and 1 across North America and Europe. The results varied greatly among studies, with 5 of them reporting PCV-10 to be more cost-effective and/or cost-saving, while 4 of them reporting PCV-13 to be more cost-effective and/or cost-saving, and 2 of them concluded in a different way: PCV-10 was more cost-effective and cost-saving, however PCV-13 would lead to higher life-years gained (LYG) and/or disability-adjusted life years (DALYs) averted.

Conclusion Due to the uncertainties in the clinical and epidemiological parameters, the unavailability of the data of local disease burden, and the analytical choices about endpoints which could significantly affect the input data, the results of the studies reviewed were contrasting from each other. Therefore, there was not enough evidence to show whether PCV-10 or PCV-13 was more cost-effective to be included into the NIP of children. Further research should be done on the sensitive variables of the cost-effectiveness ratio, as well as the local serotype distribution and disease burden should also be taken into account when planning the inclusion of PCVs into the NIP.