Cost-Effectiveness Analysis of Routine Use of 15-Valent Pneumococcal Conjugate Vaccine in the US Pediatric Population

Huang, M.; Hu, Tianyan; Weaver, Jessica; Owusu-Edusei, Kwame; Elbasha, Elamin H.

doi:10.3390/vaccines11010135

Cited by 10 publications

(3 citation statements)

References 65 publications

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“…This study differs from most other reports on PD in the US pediatric population by reporting hospital costs per admission, rather than costs estimated from Markov models of simulated clinical events [18, [20][21][22][23]. These differences in study design make comparisons among studies di cult.…”

Section: Discussionmentioning

confidence: 95%

Burden of invasive pneumococcal disease, non-invasive all-cause pneumonia, and acute otitis media in hospitalized US children: a retrospective multi-center study from 2015-2020

Mohanty,

Cossrow,

White

et al. 2024

Preprint

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Background Despite effective pneumococcal vaccines, pneumococcal disease (PD) exerts a substantial burden on children. This study explored the clinical and economic burden of invasive PD (IPD), non-invasive all-cause pneumonia (ACP), and acute otitis media (AOM) in hospitalized children, including those with antibiotic-resistant Streptococcus pneumoniae. Methods Data from the BD Insights Research Database of hospitalized children (<18 years) in the US were analyzed retrospectively. The study cohort included patients with an ICD10 code for IPD, ACP, or AOM and/or a positive culture for S. pneumoniae. Descriptive statistics and multivariable analyses evaluated the following outcomes: length of stay [LOS], hospital cost per admission, hospital margin per admission [costs – payments], and in-hospital mortality. Results The study included 4575 pediatric patients with IPD, ACP, or AOM admitted to 57 US hospitals from October 2015 to February 2020. Approximately half (50.7%) were under 2 years of age. The in-hospital mortality rate was 0.6% (n=28). The observed median (interquartile range) LOS was 4 (3, 5) days, cost per admission was $4,240 ($2,434, $8,311) US dollars, and hospital margin per admission was -$63 (‑$2,118, $2,025). Forty-one patients had S. pneumoniae-positive cultures and 56.1% of those cultures were resistant to ≥1 antibiotic class. Key variables associated with poor outcomes were having a moderate- or high-risk condition (chronic or immunocompromising), intensive care unit admission, and prior 90-day admission. Conclusions IPD, ACP, and AOM are associated with substantial clinical and economic burden in hospitalized pediatric patients in the US. S. pneumoniae isolates also showed high rates of resistance to antibiotics. Our data indicate the need for ongoing prevention efforts including vaccination and antimicrobial stewardship programs.

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Section: Discussionmentioning

confidence: 95%

Burden of invasive pneumococcal disease, non-invasive all-cause pneumonia, and acute otitis media in hospitalized US children: a retrospective multi-center study from 2015-2020

Mohanty,

Cossrow,

White

et al. 2024

Preprint

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“…In Canada [37] and Greece [60], PCV20 was estimated to be cost-saving compared with PCV15 in a 2+1 schedule. In the United Kingdom (UK), PCV20 2+1 was estimated to be cost-saving compared to PCV13 1+1 and cost-effective compared with PCV20 1+1 [61]. Moreover, a public health impact analysis in the Netherlands and estimated that PCV20 could avert 45,127 pneumococcal cases compared to PCV10 over 5 years [62].…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of PCV20 to Prevent Pneumococcal Disease in the Pediatric Population - A German Societal Perspective Analysis

Ta,

Kühne,

Laurenz

et al. 2024

Preprint

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BackgroundThe 13-valent pneumococcal conjugate vaccine (PCV13) has been included by Germany’s Standing Committee on Vaccinations for infants since 2009, resulting in major reductions in pneumococcal disease (PD). Higher-valent vaccines may further reduce PD burden. This cost-effectiveness analysis compared PCV20 under 3+1 schedule with PCV15 and PCV13, both under 2+1 schedule, in Germany’s pediatric population.MethodsA Markov model with annual cycles over a 10-year time horizon was adapted to simulate the clinical and economic consequences to the German population and compare pediatric vaccination with PCV20 to lower-valent PCVs. The model used PCV13 clinical effectiveness and impact studies as well as PCV7 efficacy studies for vaccine direct and indirect effect estimates. Epidemiologic, utility, and medical cost inputs were obtained from published sources. Benefits and costs were discounted at 3% from a German societal perspective. Outcomes included PD cases, deaths, costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs).ResultsIn the base case, PCV20 provided greater health benefits than PCV13, averting more cases of invasive pneumococcal disease (IPD; 15,301), hospitalized and non-hospitalized pneumonia (460,197 and 472,365, respectively), otitis media (531,634), and 59,265 deaths over 10 years. This resulted in 904,854 additional QALYs and a total cost-saving of €2,393,263,611, making PCV20 a dominant strategy compared with PCV13. Compared to PCV15, PCV20 was estimated to avert an additional 11,334 IPD, 704,948 pneumonia, and 441,643 otitis media cases, as well as 41,596 deaths. PCV20 was associated with a higher QALY gain and lower cost (i.e., dominance) compared with PCV15. The robustness of the results was confirmed through scenario analyses as well as deterministic and probabilistic sensitivity analyses.ConclusionPCV20 3+1 dominated both PCV13 2+1 and PCV15 2+1 over the model time horizon. Replacing lower-valent PCVs with PCV20 would result in greater clinical and economic benefits, given PCV20’s broader serotype coverage.Key Summary PointsStreptococcus pneumoniaeis the leading cause of bacterial pneumonia and global mortality in children.Pneumococcal conjugate vaccines (PCVs) elicit robust and durable immune responses in both pediatric and adult populations.This study examined the cost-effectiveness of PCV20 under a 3+1 schedule in Germany’s pediatric population compared with PCV13 and a secondary comparator (PCV15), both under a 2+1 schedule.PCV20 was estimated to prevent more pneumococcal disease cases and deaths versus PCV13 and PCV15, as well as providing greater quality-adjusted life years and cost savings (i.e., dominant strategy) over 10 years.Implementation of PCV20 under a 3+1 schedule into the German pediatric immunization program would result in greater clinical and economic benefits versus PCV13 and PCV15, both under a 2+1 schedule.Plain language summaryPneumococcal diseases (e.g., ear infections, pneumonia, bloodstream infections) are among the leading causes of illness and death in children worldwide. The pneumococcal conjugate vaccine (PCV) protects against pneumococcal diseases and has significantly reduced the number of newly diagnosed cases. Higher-valent vaccines (which provide coverage for a greater number of disease-causing serotypes) have recently received EC approval for use in adults and EC approval for use in infants is expected soon. This study examined costs and health benefits associated with the 20-valent PCV (PCV20) under a 3+1 (i.e., three primary doses and one booster dose) schedule in Germany’s childhood vaccination program compared with 13-valent PCV (PCV13) and the 15-valent PCV (PCV15), both under a 2+1 (two primary doses, one booster) schedule. PCV20 was estimated to result in greater health benefits from avoiding more cases in pneumococcal diseases and lower costs compared with both PCV13 and PCV15. PCV20, therefore, is considered the best option among the three vaccines for children in Germany.

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“…There are few studies that model the usage of PCV15 or PCV20 [ 15 , 16 , 17 ]. One study, developed for the UK, found that PCV20 would save costs and reduce disease [ 18 ]; however, that study focused on adults.…”

Section: Introductionmentioning

confidence: 99%

Estimating the Cost-Effectiveness of Switching to Higher-Valency Pediatric Pneumococcal Conjugate Vaccines in the United Kingdom

et al. 2023

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Currently, the 13-valent pneumococcal conjugate vaccine (PCV13) is administered under a 1+1 (1 primary dose) pediatric schedule in the United Kingdom (UK). Higher-valency PCVs, 15-valent PCV (PCV15), or 20-valent PCV (PCV20) might be considered to expand serotype coverage. We evaluated the cost-effectiveness of PCV20 or PCV15 using either a 2+1 (2 primary doses) or 1+1 schedule for pediatric immunization in the UK. Using a dynamic transmission model, we simulated future disease incidence and costs under PCV13 1+1, PCV20 2+1, PCV20 1+1, PCV15 2+1, and PCV15 1+1 schedules from the UK National Health Service perspective. We prospectively estimated disease cases, direct costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio. Scenario analyses were performed to estimate the impact of model assumptions and parameter uncertainty. Over a five-year period, PCV20 2+1 averted the most disease cases and gained the most additional QALYs. PCV20 2+1 and 1+1 were dominant (cost-saving and more QALYs gained) compared with PCV15 (2+1 or 1+1) and PCV13 1+1. PCV20 2+1 was cost-effective (GBP 8110/QALY) compared with PCV20 1+1. PCV20 was found cost-saving compared with PCV13 1+1, and PCV20 2+1 was cost-effective compared with PCV20 1+1. Policymakers should consider the reduction in disease cases with PCV20, which may offset vaccination costs.

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Cost-Effectiveness Analysis of Routine Use of 15-Valent Pneumococcal Conjugate Vaccine in the US Pediatric Population

Cited by 10 publications

References 65 publications

Burden of invasive pneumococcal disease, non-invasive all-cause pneumonia, and acute otitis media in hospitalized US children: a retrospective multi-center study from 2015-2020

Burden of invasive pneumococcal disease, non-invasive all-cause pneumonia, and acute otitis media in hospitalized US children: a retrospective multi-center study from 2015-2020

Cost-effectiveness of PCV20 to Prevent Pneumococcal Disease in the Pediatric Population - A German Societal Perspective Analysis

Estimating the Cost-Effectiveness of Switching to Higher-Valency Pediatric Pneumococcal Conjugate Vaccines in the United Kingdom

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