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Cost-effectiveness analysis of a universal mass vaccination program with a PHiD-CV 2+1 schedule in Malaysia
Xiao Jun Wang1,2, Ashwini Saha3, Xu-Hao Zhang1,2
1Department of Pharmacy, National University of Singapore, Block S4A, Level 3, 18 Science Drive 4, Singapore, 117543 Singapore.
Insights
A pneumococcal polysaccharide and non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) 2+1 schedule is cost-effective for Malaysian children, significantly reducing disease burden. This PHiD-CV program dominates the 13-valent pneumococcal conjugate vaccine (PCV13) program.
Area of Science:
- Public Health
- Vaccinology
- Health Economics
Background:
- Malaysia has PCV13 and PHiD-CV vaccines available privately.
- Evaluating universal vaccination programs is crucial for public health policy.
Purpose of the Study:
- To assess the cost-effectiveness of a PHiD-CV 2+1 schedule universal vaccination program.
- Compare PHiD-CV 2+1 to no vaccination and PCV13 2+1 schedules in Malaysia.
Main Methods:
- A Markov cohort model was adapted for epidemiological and economic evaluation over 10 years.
- Data from Malaysia and published literature were used, validated by experts.
- Analyses included disease cases, deaths, costs, QALYs, and ICERs, with sensitivity analyses.
Main Results:
- PHiD-CV 2+1 is projected to prevent significant cases of IPD, pneumonia, and AOM, with 1084 additional QALYs at an ICER of $28,497/QALY compared to no vaccination.
- PHiD-CV 2+1 demonstrated cost savings of $5.2 million and gained 116 QALYs, dominating the PCV13 2+1 schedule.
- Sensitivity analyses confirmed the robustness of these findings.
Conclusions:
- A PHiD-CV 2+1 universal vaccination program is cost-effective and reduces pneumococcal disease burden in Malaysia.
- PHiD-CV 2+1 is the dominant strategy compared to PCV13 2+1 for universal vaccination in Malaysia.
Background:
Currently, two pediatric pneumococcal conjugate vaccines are available in the private market of Malaysia-13-valent pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide and non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV). This study aimed to evaluate the cost-effectiveness of a universal mass vaccination program with a PHiD-CV 2+1 schedule versus no vaccination or with a PCV13 2+1 schedule in Malaysia.
Methods:
A published Markov cohort model was adapted to evaluate the epidemiological and economic consequences of programs with no vaccination, a PHiD-CV 2+1 schedule or a PCV13 2+1 schedule over a 10-year time horizon. Disease cases, deaths, direct medical costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were estimated. Locally published epidemiology and cost data were used whenever possible. Vaccine effectiveness and disutility data were based on the best available published data. All data inputs and assumptions were validated by local clinical and health economics experts. Analyses were conducted from the perspective of the Malaysian government for a birth cohort of 508,774. Costs and QALYs were discounted at 3% per annum. One-way and probabilistic sensitivity analyses were performed.
Results:
Compared with no vaccination, a PHiD-CV 2+1 program was projected to prevent 1109 invasive pneumococcal disease (IPD), 24,679 pneumonia and 72,940 acute otitis media (AOM) cases and 103 IPD/pneumonia deaths over 10 years, with additional costs and QALYs of United States dollars (USD) 30.9 million and 1084 QALYs, respectively, at an ICER of USD 28,497/QALY. Compared with a PCV13 2+1 program, PHiD-CV 2+1 was projected to result in similar reductions in IPD cases (40 cases more) but significantly fewer AOM cases (30,001 cases less), with cost savings and additional QALYs gained of USD 5.2 million and 116 QALYs, respectively, demonstrating dominance over PCV13. Results were robust to variations in one-way and probabilistic sensitivity analyses.
Conclusions:
A PHiD-CV 2+1 universal mass vaccination program could substantially reduce pneumococcal disease burden versus no vaccination, and was expected to be cost-effective in Malaysia. A PHiD-CV 2+1 program was also expected to be a dominant choice over a PCV13 2+1 program in Malaysia.
