Cost-Effectiveness of Using 2 vs 3 Primary Doses of 13-Valent Pneumococcal Conjugate Vaccine

Abstract

BACKGROUND AND OBJECTIVE: Although effective in preventing pneumococcal disease, 13-valent pneumococcal conjugate vaccine (PCV13) is the most expensive vaccine on the routinely recommended pediatric schedule in the United States. We examined the cost-effectiveness of switching from 4 total doses to 3 total doses by removing the third dose in the primary series in the United States. METHODS: We used a probabilistic model following a single birth cohort of 4.3 million to calculate societal cost savings and increased disease burden from removing the 6-month dose of PCV13. Based on modified estimates of 7-valent pneumococcal conjugate vaccine from randomized trials and observational studies, we assumed that vaccine effectiveness under the 2 schedules is identical for the first 6 months of life and largely similar after administration of the 12- to 15-month booster dose. RESULTS: Removing the third dose of PCV13 would annually save $500 million (in 2011$) but would also result in an estimated 2.5 additional deaths among inpatients with pneumonia or invasive pneumococcal disease. Such dose removal would also result in 261 000 estimated otitis media and 12 000 estimated pneumonia cases annually. These additional illnesses could be prevented through modest increases in coverage. Overall, societal savings per additional life-year lost would be ∼$6 million. When nonfatal outcomes are also considered, savings would range from $143 000 to $4 million per additional quality adjusted life-year lost, depending on the assumptions used for otitis media. CONCLUSIONS: Sizable societal cost savings and a moderate pneumococcal disease increase could be expected from removing the PCV13 primary series’ third dose.

Cost analysis of measles in refugees arriving at Los Angeles International Airport from Malaysia

“…Published domestic analyses of vaccines' cost-effectiveness define denominator populations explicitly, e.g., a birth cohort or a group diagnosed with a disease 13,14 . Because US-bound refugees are a small set of all refugees from Malaysia, live in an urban setting, and came from a wide variety of geographic areas in the years before domestic resettlement, their true population was unknown.…”

Immunization Update V

“…A recently published article studied models for changing the current dosing schedule of 4 doses of the conjugated pneumococcal vaccine to a 3-dose schedule [45]. Some experts have serious reservations about changing the current conjugated pneumococcal vaccine schedule in the United States.…”

Use of Pneumococcal Disease Epidemiology to Set Policy and Prevent Disease during 20 Years of the Emerging Infections Program

“…The cost per IPD episode averted without consideration of herd protection was $33,000, and the cost per episode averted with herd protection decreased to $5,500. This observation fundamentally changed the method for cost-effectiveness analyses of pneumococcal conjugate vaccines, not only in the United States ( 20 , 21 ) but also in other countries ( 22 , 23 ). A subsequent analysis, which incorporated the effect on pneumonia from non-EIP data sources, found PCV7 to be cost-saving (i.e., improved health outcomes at lower costs) ( 20 ).…”