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Potential impact of introducing the pneumococcal conjugate vaccine into national immunisation programmes: an
Itamar Megiddo1,2, Eili Klein2,3, Ramanan Laxminarayan1,2,4
1Department of Management Science, University of Strathclyde, Glasgow, UK.
Insights
Pneumococcal conjugate vaccine (PCV) introduction in India is cost-effective, averting thousands of child deaths and protecting the poorest from catastrophic health expenses. The vaccine offers significant value, especially when considering long-term financial risk protection.
Area of Science:
- Public Health
- Epidemiology
- Health Economics
Background:
- Pneumococcal pneumonia is a leading cause of child mortality in India, with an estimated 105,000 deaths annually.
- The planned introduction of the pneumococcal conjugate vaccine (PCV) aims to reduce child deaths but faces cost concerns.
- Cost-effectiveness of PCV is difficult to compare across countries due to variations in serotype distribution, population demographics, and healthcare systems.
Purpose of the Study:
- To evaluate the cost-effectiveness and disease dynamics of introducing the pneumococcal conjugate vaccine (PCV13) in India.
- To model serotype-specific and overall disease dynamics using a localized agent-based simulation.
- To assess the financial risk protection offered by PCV, particularly for vulnerable populations.
Main Methods:
- Utilized IndiaSim, an agent-based simulation model representing the Indian population and healthcare system.
- Modeled the dynamics of *Streptococcus pneumoniae* to evaluate serotype and disease patterns.
- Assessed costs, averted deaths, and out-of-pocket expenditure reductions at ~77% and 90% vaccine coverage levels.
Main Results:
- PCV13 introduction at ~77% coverage is estimated to cost $240 million and avert 34,800 child deaths annually.
- The vaccine is projected to save $48.7 million in out-of-pocket expenditures, offering significant financial protection, especially to the poorest quintile.
- The net-present value of the vaccine's insurance value over 20 years is substantial, with nearly half benefiting the lowest wealth quintile.
Conclusions:
- Introducing PCV13 in India is a cost-effective strategy for reducing child mortality and preventing catastrophic health expenditures.
- The vaccine provides significant financial risk protection, disproportionately benefiting the poorest populations.
- Increased coverage to 90% further enhances life-saving and financial protection benefits, reinforcing the value of PCV implementation.
Abstract:
Pneumococcal pneumonia causes an estimated 105 000 child deaths in India annually. The planned introduction of the serotype-based pneumococcal conjugate vaccine (PCV) is expected to avert child deaths, but the high cost of PCV relative to current vaccines provided under the Universal Immunization Programme has been a concern. Cost-effectiveness studies from high-income countries are not readily comparable because of differences in the distribution of prevalent serotypes, population and health systems. We extended IndiaSim, our agent-based simulation model representative of the Indian population and health system, to model the dynamics of Streptococcus pneumoniae. This enabled us to evaluate serotype and overall disease dynamics in the context of the local population and health system, an aspect that is missing in prospective evaluations of the vaccine. We estimate that PCV13 introduction would cost approximately US$240 million and avert US$48.7 million in out-of-pocket expenditures and 34 800 (95% CI 29 600 to 40 800) deaths annually assuming coverage levels and distribution similar to DPT (diphtheria, pertussis and tetanus) vaccination (~77%). Introducing the vaccine protects the population, especially the poorest wealth quintile, from potentially catastrophic expenditure. The net-present value of predicted money-metric value of insurance for 20 years of vaccination is US$160 000 (95% CI US$151 000 to US$168 000) per 100 000 under-fives, and almost half of this protection is for the bottom wealth quintile (US$78 000; 95% CI 70 800 to 84 400). Extending vaccination to 90% coverage averts additional lives and provides additional financial risk protection. Our estimates are sensitive to immunity parameters in our model; however, our assumptions are conservative, and if willingness to pay per years of life lost averted is US$228 or greater, then introducing the vaccine is more cost-effective than our baseline (no vaccination) in more than 95% of simulations.
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