The cost-effectiveness of a 13-valent pneumococcal conjugate vaccination for infants in England

Albert Jan Van Hoek*, Yoon Hong Choi, Caroline Trotter, Elizbeth Miller, Mark Jit

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    30 Citations (Scopus)

    Abstract

    Background: In the immunisation schedule in England and Wales, the 7-valent pneumococcal conjugate vaccine (PCV-7) was replaced by the 13-valent vaccine (PCV-13) in April 2010 after having been used since September 2006. The introduction of PCV-7 was informed by a cost effectiveness analysis using an infectious disease model which projected herd immunity and serotype replacement effects based on the post-vaccine experience in the United States at that time. Aim: To investigate the cost effectiveness of the introduction of PCV-13. Method: Invasive disease incidence following vaccination was projected from a dynamic infectious disease model, and combined with serotype specific disease outcomes obtained from a large hospital dataset linked to laboratory confirmation of invasive pneumococcal disease. The economic impact of replacing PCV-7 with PCV-13 was compared to stopping the use of pneumococcal conjugate vaccination altogether. Results: Discontinuing PCV-7 would lead to a projected increase in invasive pneumococcal disease, costs and loss of quality of life compared to the introduction of PCV-13. However under base case assumptions (assuming no impact on non-invasive disease, maximal competition between vaccine and non-vaccine types, time horizon of 30. years, vaccine price of £49.60 a dose. +. £7.50 administration costs and discounting of costs and benefits at 3.5%) the introduction of PCV-13 is only borderline cost effective compared to a scenario of discontinuing of PCV-7. The intervention becomes more cost-effective when projected impact of non-invasive disease is included or the discount factor for benefits is reduced to 1.5%. Conclusion: To our knowledge this is the first evaluation of a transition from PCV-7 to PCV-13 based on a dynamic model. The cost-effectiveness of such a policy change depends on a number of crucial assumptions for which evidence is limited, particularly the impact of PCV-13 on non-invasive disease.

    Original languageEnglish
    Pages (from-to)7205-7213
    Number of pages9
    JournalVaccine
    Volume30
    Issue number50
    DOIs
    Publication statusPublished - 26 Nov 2012

    Bibliographical note

    Funding Information:
    This work was supported by the UK Department of Health Policy Research Programme , grant number: 039/0031 to AJvH. The views expressed in the publication are those of the authors and not necessarily those of the Department of Health.

    Keywords

    • Burden of disease
    • Cost-effectiveness
    • PCV-13
    • Pneumococcal conjugate vaccine

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