Cost-effectiveness of the 13-valent pneumococcal conjugate vaccine compared to the 10-valent vaccine in children: predictive analysis in the Ecuadorian context

Bolaños-Díaz R.; Miño-León G.; Zea E. · Journal of Pharmaceutical Health Services Research (2022) · DOI: 10.1093/jphsr/rmac040

Resumen

Objective: To evaluate the cost-effectiveness and economic impact of changing childhood vaccination from the 10-valent pneumococcal conjugate vaccine (PCV10) to the 13-valent pneumococcal conjugate vaccine (PCV13) in the context of the Ecuadorian health system. Methods: A Markov model was developed based on a hypothetical cohort of children <1 year old with a 2 + 1 vaccination schedule. The model incorporates the most impactful chronic sequelae of invasive pneumococcal disease: bilateral hearing loss, spasticity, neurological deficit, hydrocephalus and epilepsy. At the end of each annual Markov cycle, the children heal with/without sequelae or die. A time horizon of 5 years was considered. The analysis was done from the perspective of the Ministry of Health. Key findings: Vaccination with PCV13 is cost-saving (US$ -2940/QALY) in relation to PCV10 considering indirect effects ('herd effect') of childhood vaccination over adult population (>65 years). So, PCV13 reduces incident cases of IPD in this adult population by 27.8% compared to PCV10. Simulation of the model in a cohort of 100 000 children <1 year old showed an incidence of 25 cases of IPD with PCV13 versus 40 cases with PCV10, that is, a reduction of 37.5%. A reduction compared to PCV10 in the incidence of pneumonia and meningitis of 30.2 and 57.1%, respectively, was demonstrated. PCV13 decreased mortality by 32% compared to PCV10. Conclusions: Vaccination with PCV13 is cost-saving in the Ecuadorian health context and significantly reduces morbidity and mortality in children <5 years and in adults >65 years due to the herd effect. The probabilistic analysis showed consistency in the results.

Instituciones: Universidad Nacional Federico Villarreal