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Constrained Optimization for Pneumococcal Vaccination in Brazil
Jan Olbrecht1, Jorge A Gomez2, Laure-Anne Van Bellinghen3
1GlaxoSmithKline, Wavre, Belgium.
Insights
This study identifies the most cost-efficient pneumococcal vaccination strategy for Brazil over 10 years. Constrained optimization maximized health gains within budget limits, offering a valuable public health planning tool.
Area of Science:
- Public Health
- Health Economics
- Vaccinology
Background:
- Pneumococcal disease remains a significant public health concern globally.
- Cost-effective vaccination strategies are crucial for resource allocation in healthcare systems.
- Brazil's current vaccination program requires ongoing evaluation for optimal impact.
Purpose of the Study:
- To determine the most cost-efficient combination of pneumococcal vaccines for infants and aging adults in Brazil over a 10-year period.
- To utilize constrained optimization to balance health gains with budget limitations.
- To inform national immunization policy and resource allocation.
Main Methods:
- Employed constrained optimization (CO) to prioritize pneumococcal vaccine regimens based on quality-adjusted life-years (QALYs) gained and costs.
- Analyzed a 10-year time horizon with specific constraints on budget, return on investment (ROIR > 1), and vaccine coverage.
- Modeled the current infant vaccination strategy using pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) as a baseline.
Main Results:
- The CO analysis identified a strategy yielding 126,194 additional QALYs over 10 years for an extra budget of 974 million Brazilian reals (ROIR = 1.15).
- The model suggests potential for improved outcomes with increased at-risk population coverage in aging adults, reduced herd effects, and enhanced QALY scores.
- The optimized strategy balances budget constraints with significant public health benefits.
Conclusions:
- Constrained optimization effectively identifies cost-efficient pneumococcal vaccination strategies within defined parameters.
- The study demonstrates that optimizing vaccine combinations can achieve substantial health gains while adhering to budget limitations.
- Findings support evidence-based decision-making for national immunization programs in Brazil and similar settings.
Objectives:
To identify the most cost-efficient combination of pneumococcal vaccines in infants and aging adults for a 10-year period in Brazil.
Methods:
Constrained optimization (CO) prioritized 9 pneumococcal vaccine regimens according to their gain in quality-adjusted life-years (QALYs) and their related costs over a prespecified time horizon with defined constraints for 2 age groups, infants and aging adults. The analysis starts from the current universal infant vaccination of pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV), 2 primary and 1 booster dose at 2, 4, and 12 months, respectively. Key constraints are the fixed annual vaccine budget increase and the relative return on investment (ROIR) per regimen, which must be > 1, the reference intervention being the current vaccination strategy in infants and the most cost-efficient one in aging adults.
Results:
The CO analysis including all the constraints indicates that over 10 years the maximum extra health gain is 126 194 QALYs for an extra budget of $974 million Brazilian reals (ROIR = 1.15). Results could be improved with a higher proportion of the at-risk population in aging adults, less herd effect, and better QALY scores.
Conclusion:
The study shows that with 4 constraints on budget, time horizon, vaccine coverage, and cost efficiency, a CO analysis could identify the most cost-efficient overall pneumococcal vaccination strategy for Brazil, allowing for limited vaccine budget increase while obtaining appropriate health gain.
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