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Pneumococcal Vaccination in Children: A Systematic Review and Meta-Analysis of Cost-Effectiveness Studies
M Sakil Syeed1, Priyanka Ghule1, Lan M Le1
1University of Utah College of Pharmacy, Salt Lake City, UT, USA.
Insights
Pneumococcal conjugate vaccines (PCVs) offer significant health benefits. The 13-valent PCV (PCV13) demonstrates cost-effectiveness over the 10-valent PCV (PCV10) when herd effects are considered, particularly from a payer perspective.
Area of Science:
- Public Health
- Health Economics
- Vaccinology
Background:
- Pneumococcal conjugate vaccines (PCVs) are crucial in reducing global childhood morbidity and mortality from Streptococcus pneumoniae.
- Assessing the incremental net benefit (INB) of different PCV valencies is vital for optimizing public health resource allocation.
Approach:
- A systematic review and meta-analysis of cost-effectiveness and cost-utility studies published before May 2022.
- Included studies compared 13-valent PCV (PCV13) or 10-valent PCV (PCV10) against no vaccination or each other in pediatric populations.
- Monetary values were standardized to 2021 US dollars, and INBs were pooled using random-effect models, stratified by country income, perspective, and herd effects.
Key Points:
- PCV13 showed a statistically significant incremental net benefit over PCV10 from the payer perspective in both high-income countries (HICs) and low- and middle-income countries (LMICs) when herd effects were included.
- PCV13 was consistently cost-effective compared to no vaccination across various settings and perspectives.
- Findings for PCV10 compared to no vaccination were less consistent, highlighting the value of higher valency vaccines.
Conclusions:
- Pneumococcal conjugate vaccines are generally cost-effective interventions compared to no vaccination in both HICs and LMICs.
- PCV13 offers a demonstrable cost-effective advantage over PCV10 when herd immunity effects are factored into payer perspectives.
- The consideration of herd effects is a critical determinant in the economic evaluation of PCVs.
Objectives:
Pneumococcal conjugate vaccines (PCVs) have significantly reduced disease burden caused by Streptococcus pneumoniae, a leading cause of childhood morbidity and mortality globally. This systematic review and meta-analysis aimed to assess the incremental net benefit (INB) of the 13-valent PCV (PCV13) and 10-valent PCV (PCV10) in children.
Methods:
We performed a comprehensive search in several databases published before May 2022. Studies were included if they were cost-effectiveness or cost-utility analyses of PCV13 or PCV10 compared with no vaccination or with each other in children. Various monetary units were converted to purchasing power parity, adjusted to 2021 US dollars. The INBs were calculated and then pooled across studies stratified by country income level, perspective, and consideration of herd effects, using a random-effect model.
Results:
Seventy studies were included. When herd effects were considered, PCV13 was cost-effective compared with PCV10 from the payer perspective in both high-income countries (HICs) (INB, $103.94; 95% confidence interval, $75.28-$132.60) and low- and middle-income countries (LMICs) (INB, $53.49; 95% confidence interval, $30.42-$76.55) with statistical significance. These findings were robust across a series of sensitivity analyses. PCV13 was cost-effective compared with no vaccination across perspectives and consideration of herd effects in both HICs and LMICs, whereas findings were less consistent for PCV10.
Conclusion:
PCVs were generally cost-effective compared with no vaccination in HICs and LMICs. Our study found that PCV13 was cost-effective compared with PCV10 when herd effects were considered from the payer perspective in both HICs and LMICs. The results are sensitive to the consideration of herd effects.
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