Clinical and Economic Impact of a Potential Switch from 13-Valent to 10-Valent Pneumococcal Conjugate Infant Vaccination in Canada

Abstract

IntroductionPneumococcal conjugate vaccines (PCVs) have been available in Canada since 2001, with 13-valent PCV (PCV13) added to the infant routine immunization program throughout all Canadian provinces by 2011. The use of PCVs has dramatically reduced the burden of pneumococcal disease in Canada. As a result, decision-makers may consider switching from a more costly, higher-valent vaccine to a lower-cost, lower-valent vaccine in an attempt to allocate funds for other vaccine programs. We assessed the health and economic impact of switching the infant vaccination program from PCV13 to 10-valent PCV (PCV10) in the context of the Canadian health care system.MethodsWe performed a review of Canadian databases supplemented with published and unpublished data to obtain the historical incidence of pneumococcal disease and direct and indirect medical costs. Observed invasive pneumococcal disease (IPD) trends from surveillance data were used as a basis to forecast the future number of cases of IPD, pneumococcal pneumonia, and acute otitis media given a PCV13- or PCV10-based program. Costs and outcomes over 10 years were then estimated and presented in 2017 Canadian dollars discounted at 3% per year.ResultsSwitching from PCV13 to PCV10 would result in an additional 762,531 cases of pneumococcal disease over 10 years. Although PCV13 has a higher acquisition cost, switching to PCV10 would increase overall costs by over $500 million. Forecasted overall disease incidence was estimated substantially higher with PCV10 than with PCV13 primarily because of the potential reemergence of serotypes 3 and 19A. PCV13 was also cost saving compared with PCV10, even within a 5-year time horizon. Probabilistic sensitivity analysis showed that a PCV13-based program remained cost saving in all simulations.ConclusionAlthough switching to a PCV10-based infant vaccination program in Canada might result in lower acquisition costs, it would also result in higher public health cost and burden because of serotype reemergence.FundingPfizer Inc.Electronic supplementary materialThe online version of this article (10.1007/s40121-018-0206-1) contains supplementary material, which is available to authorized users.

Estimating the Clinical and Economic Impact of Switching from the 13-Valent Pneumococcal Conjugate Vaccine (PCV13) to the 10-Valent Pneumococcal Conjugate Vaccine (PCV10) in Italy

“…The findings obtained by modeling the clinical and economic impact of pediatric pneumococcal conjugate vaccine programs in Italy are consistent with those of several studies [16,17] that applied a similar forecasting decision-analytic model in the Canadian and Mexican contexts and with the real experience of Belgium (Flanders and Wallonia) where the switch caused a ten-fold increase in the number of 19A pneumococcal disease isolates from 2015 to 2017 [13].…”

“…Although some other studies describe the health and economic impact of switching the infant vaccination program from 13-to 10-valent PCV [16][17][18], this analysis estimates the impact based on the epidemiology and serotype dynamics specific to PCV experience in Italy. In order to better define the serotype dynamics, data from the most sensitive regional surveillance systems were used and were considered representative of the incidence rate across the entire country, as no potential bias was knowingly introduced.…”

Comment on Gomez et. al. “Response to article by Wasserman et. al. (2018) ‘Modelling the sustained use of the 13-valent pneumococcal conjugate vaccine compared to switching to the 10-valent vaccine in Mexico’”

“…The Mexico perspective was also the second publication of this methodology, for which there are additional data summarizing particular assumptions available for the reader. 9 In our model, both PCV10 and PCV13 largely eliminate disease caused by the 10 common serotypes. As already discussed above, the difference in the 0-2 age group is driven primarily by replacement of 19A disease in the PCV10 arm, which was has been observed in numerous countries using PCV10.…”

Estimating the population health and economic impacts of introducing a pneumococcal conjugate vaccine in Malaysia- an economic evaluation

“…An existing pneumococcal disease forecasting model was adapted. 14 The model was built using real-world pre-and post-PCV surveillance data from PCV10 (e.g. Finland and the Netherlands) and PCV13 (e.g.…”