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Clinical and Economic Impact of a Potential Switch from 13-Valent to 10-Valent Pneumococcal Conjugate Infant
Michele Wilson1, Matt Wasserman2, Taj Jadavi3
1RTI Health Solutions, Research Triangle Park, Durham, NC, United States. mwilson@rti.org.
Insights
Switching from 13-valent pneumococcal conjugate vaccine (PCV13) to 10-valent PCV (PCV10) in Canada would increase disease cases and public health costs. A PCV13-based program is more cost-effective and prevents serotype reemergence.
Area of Science:
- Public Health
- Vaccinology
- Health Economics
Background:
- Pneumococcal conjugate vaccines (PCVs) have significantly reduced pneumococcal disease in Canada since 2001.
- 13-valent PCV (PCV13) has been part of the routine infant immunization program since 2011.
- Decision-makers may consider switching to lower-valent, lower-cost vaccines to reallocate resources.
Purpose of the Study:
- To assess the health and economic impact of switching Canada's infant vaccination program from PCV13 to 10-valent PCV (PCV10).
- To evaluate the cost-effectiveness and disease burden associated with PCV10 versus PCV13 in the Canadian healthcare system.
Main Methods:
- A review of Canadian databases for historical pneumococcal disease incidence and medical costs.
- Forecasting future cases of invasive pneumococcal disease (IPD), pneumococcal pneumonia, and acute otitis media.
- Estimating 10-year costs and outcomes in 2017 Canadian dollars, discounted at 3% annually.
Main Results:
- Switching to PCV10 would lead to an additional 762,531 pneumococcal disease cases over 10 years.
- PCV10 would increase overall costs by over $500 million due to potential reemergence of serotypes 3 and 19A.
- PCV13 was found to be cost-saving compared to PCV10, even within a 5-year timeframe.
Conclusions:
- Switching to PCV10 may lower acquisition costs but would increase public health costs and disease burden.
- A PCV13-based program is cost-saving and prevents serotype reemergence.
- PCV13 vaccination programs demonstrate sustained cost-effectiveness in Canada.
Introduction:
Pneumococcal conjugate vaccines (PCVs) have been available in Canada since 2001, with 13-valent PCV (PCV13) added to the infant routine immunization program throughout all Canadian provinces by 2011. The use of PCVs has dramatically reduced the burden of pneumococcal disease in Canada. As a result, decision-makers may consider switching from a more costly, higher-valent vaccine to a lower-cost, lower-valent vaccine in an attempt to allocate funds for other vaccine programs. We assessed the health and economic impact of switching the infant vaccination program from PCV13 to 10-valent PCV (PCV10) in the context of the Canadian health care system.
Methods:
We performed a review of Canadian databases supplemented with published and unpublished data to obtain the historical incidence of pneumococcal disease and direct and indirect medical costs. Observed invasive pneumococcal disease (IPD) trends from surveillance data were used as a basis to forecast the future number of cases of IPD, pneumococcal pneumonia, and acute otitis media given a PCV13- or PCV10-based program. Costs and outcomes over 10 years were then estimated and presented in 2017 Canadian dollars discounted at 3% per year.
Results:
Switching from PCV13 to PCV10 would result in an additional 762,531 cases of pneumococcal disease over 10 years. Although PCV13 has a higher acquisition cost, switching to PCV10 would increase overall costs by over $500 million. Forecasted overall disease incidence was estimated substantially higher with PCV10 than with PCV13 primarily because of the potential reemergence of serotypes 3 and 19A. PCV13 was also cost saving compared with PCV10, even within a 5-year time horizon. Probabilistic sensitivity analysis showed that a PCV13-based program remained cost saving in all simulations.
Conclusion:
Although switching to a PCV10-based infant vaccination program in Canada might result in lower acquisition costs, it would also result in higher public health cost and burden because of serotype reemergence.
Funding:
Pfizer Inc.
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