Estimating the cost-effectiveness of an infant 13-valent pneumococcal conjugate vaccine national immunization program in China

Abstract

BackgroundThe burden of pneumococcal disease in China is high, and a 13-valent pneumococcal conjugate vaccine (PCV13) recently received regulatory approval and is available to Chinese infants. PCV13 protects against the most prevalent serotypes causing invasive pneumococcal disease (IPD) in China, but will not provide full societal benefits until made broadly available through a national immunization program (NIP).ObjectiveTo estimate clinical and economic benefits of introducing PCV13 into a NIP in China using local cost estimates and accounting for variability in vaccine uptake and indirect (herd protection) effects.MethodsWe developed a population model to estimate the effect of PCV13 introduction in China. Modeled health states included meningitis, bacteremia, pneumonia (PNE), acute otitis media, death and sequelae, and no disease. Direct healthcare costs and disease incidence data for IPD and PNE were derived from the China Health Insurance and Research Association database; all other parameters were derived from published literature. We estimated total disease cases and associated costs, quality-adjusted life years (QALYs), and deaths for three scenarios from a Chinese Payer Perspective: (1) direct effects only, (2) direct+indirect effects for IPD only, and (3) direct+indirect effects for IPD and inpatient PNE.ResultsScenario (1) resulted in 370.3 thousand QALYs gained and 12.8 thousand deaths avoided versus no vaccination. In scenarios (2) and (3), the PCV13 NIP gained 383.2 thousand and 3,580 thousand QALYs, and avoided 13.1 thousand and 147.5 thousand deaths versus no vaccination, respectively. In all three scenarios, the vaccination cost was offset by cost reductions from prevented disease yielding net costs of ¥29,362.32 million, ¥29,334.29 million, and ¥13,524.72 million, respectively. All resulting incremental cost-effectiveness ratios fell below a 2x China GDP cost-effectiveness threshold across a range of potential vaccine prices.DiscussionInitiation of a PCV13 NIP in China incurs large upfront costs but is good value for money, and is likely to prevent substantial cases of disease among children and non-vaccinated individuals.

Clinical characteristics and antimicrobial resistance of pneumococcal isolates of pediatric invasive pneumococcal disease in China

“…PCV7 was approved by the Chinese Food and Drug Administration in 2008; however, uptake was low and concentrated in cities. 30 , 31 The administration approved PCV13 for use in infants and children in a 3+1 schedule at 2, 4, and 6 months of age, with a fourth (booster) dose administered at approximately 12–15 months of age in 2016. 31 , 32 However, PCV is currently available only for infants whose parents are able to pay for the vaccine.…”

“… 30 , 31 The administration approved PCV13 for use in infants and children in a 3+1 schedule at 2, 4, and 6 months of age, with a fourth (booster) dose administered at approximately 12–15 months of age in 2016. 31 , 32 However, PCV is currently available only for infants whose parents are able to pay for the vaccine. Studies have shown that PCV coverage was around 10% for children aged 2–7 years living in Shanghai, and locals had higher coverage than the floating population.…”

Pneumococcal Vaccination for Children in Asian Countries: A Systematic Review of Economic Evaluation Studies

“…Seven studies assessed the cost-effectiveness of PCV-7 [27,29,30,32,33,39,46], of which one study assessed its effectiveness in the context of typical and pandemic influenza seasons [30]. PCV-13 was assessed in six studies [35,38,40,41,43,45] and comparisons of various types of vaccines were performed in two studies [26,48]. The majority of studies used quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs) as the health outcomes measure [20,25,26,32,[35][36][37][38][39][40][41]44,47,48] while the rest combined both the clinical and the utility outcomes or provided only clinical outcomes, e.g., cases of pneumococcal-related diseases and life years.…”

“…The included studies were conducted in 11 Asian countries, including China (n = 7) [26,30,32,33,35,41,48] Malaysia (n = 3) [34,42,44], Hong Kong (n = 3) [28,29,42] Korea (n = 2) [25,46], The Philippines (n = 2) [31,36],Taiwan (n = 2) [27,43], Japan (n = 3) [20,38,39], Thailand (n = 1) [47], Mongolia (n = 1) [45], Bhutan (n = 1) [37], and India (n = 1) [40] (Table 1). One study was a multiple country analysis, performed in Malaysia and Hong Kong [42].…”

Cost of Nine Pediatric Infectious Illnesses in Low- and Middle-Income Countries: A Systematic Review of Cost-of-Illness Studies

“…Particularly, we found two studies assessing the cost of measles in the Federated States of Micronesia [49] and the cost of measles and rubella in Romania [50] -a first for measles and rubella in LMIC. Other studies examined further the cost of GE [51][52][53][54][55][56][57][58][59], pneumonia [51,52,[59][60][61][62][63], and influenza [64,65]. Some of them generated COI estimates from a programmatic approach, evaluating the cost of treating diarrhea and pneumonia through an integrated community case management [51,52,59].…”