Do Pneumococcal Conjugate Vaccines Represent Good Value for Money in a Lower-Middle Income Country? A Cost-Utility Analysis in the Philippines

Abstract

ObjectivesThe objective of this study is to assess the value for money of introducing pneumococcal conjugate vaccines as part of the immunization program in a lower-middle income country, the Philippines, which is not eligible for GAVI support and lower vaccine prices. It also includes the newest clinical evidence evaluating the efficacy of PCV10, which is lacking in other previous studies.MethodsA cost-utility analysis was conducted. A Markov simulation model was constructed to examine the costs and consequences of PCV10 and PCV13 against the current scenario of no PCV vaccination for a lifetime horizon. A health system perspective was employed to explore different funding schemes, which include universal or partial vaccination coverage subsidized by the government. Results were presented as incremental cost-effectiveness ratios (ICERs) in Philippine peso (Php) per QALY gained (1 USD = 44.20 Php). Probabilistic sensitivity analysis was performed to determine the impact of parameter uncertainty.ResultsWith universal vaccination at a cost per dose of Php 624 for PCV10 and Php 700 for PCV13, both PCVs are cost-effective compared to no vaccination given the ceiling threshold of Php 120,000 per QALY gained, yielding ICERs of Php 68,182 and Php 54,510 for PCV10 and PCV13, respectively. Partial vaccination of 25% of the birth cohort resulted in significantly higher ICER values (Php 112,640 for PCV10 and Php 84,654 for PCV13) due to loss of herd protection. The budget impact analysis reveals that universal vaccination would cost Php 3.87 billion to 4.34 billion per annual, or 1.6 to 1.8 times the budget of the current national vaccination program.ConclusionThe inclusion of PCV in the national immunization program is recommended. PCV13 achieved better value for money compared to PCV10. However, the affordability and sustainability of PCV implementation over the long-term should be considered by decision makers.

Health Technology Assessment capacity development in low- and middle-income countries: Experiences from the international units of HITAP and NICE

“…A key lesson learnt is that the development of HTA capacity can be catalyzed by beginning with a topic that the technical experts have already assessed, which is advantageous because the experts then have materials and relevant experiences to share to the local partners. This led to the completion of these projects in one year, compared to three years for the Thai studies, and two international publications in well-known journals 29 , 30 .…”

Vaccination program in a resource-limited setting: A case study in the Philippines

“…An associated cost-effectiveness analysis found that the universal coverage for PCV13 has the lowest ICER compared to no vaccination amongst the four vaccination strategies [11] . Although this policy needs an additional 380 FTEs for general practitioners, 602 FTEs for nurses, and 205 FTEs for midwives, it can reduce the number of FTEs for medical social workers, paediatricians, infectious disease specialists, neurologists, anaesthesiologists, radiologists, ultrasonologists, medical technologists, radiologic technologists and pharmacists by 7, 17.9, 9.7, 0.4, 0.1, 0.7, 0.1, 12.3, 2, and 9.7, respectively, when compared to the no vaccination policy.…”

“…with and without the vaccination program. The number of cases for each disease was estimated using the Markov model from a prior economic evaluation study that was conducted in the Philippines [11] . One-year time horizon was employed in this study, while the prior economic evaluation used a Markov model with a lifetime horizon.…”

“…Therefore, this study aims to take this challenge by estimating the HRH needed and reduced as a result of introducing the pneumococcal conjugate vaccine (PCV). This study is conducted as an additional analysis to the economic evaluation using the Philippines as a case study due to their existing economic model which compares various vaccination policy options [11] .…”

Incorporating economies of scale in the cost estimation in economic evaluation of PCV and HPV vaccination programmes in the Philippines: a game changer?

“…Two economic evaluation models used for previous economic evaluations of PCV and HPV in the Philippines were deployed in this study. Details of the models are described elsewhere in open-access journals [ 10 , 11 ]. Briefly, the two models compared both the costs and outcome of the PCV and HPV vaccination with 0–1 years for both boys and girls, and 11 years and above for girls, respectively.…”