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Cost-effectiveness analysis of a maternal pneumococcal vaccine in low-income, high-burden settings such as Sierra
Gizem M Bilgin1, Syarifah Liza Munira1, Kamalini Lokuge1
1National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia.
Insights
Maternal pneumococcal vaccines offer cost-effective infant protection in low-income nations, particularly from a societal viewpoint. Vaccine pricing is crucial for widespread adoption and self-financing by these countries.
Area of Science:
- Public Health
- Vaccinology
- Health Economics
Background:
- Maternal pneumococcal vaccination is a strategy to protect infants from severe pneumococcal diseases.
- Assessing cost-effectiveness is vital for implementing new public health interventions in low-income settings.
Purpose of the Study:
- To evaluate the cost-effectiveness of a maternal pneumococcal polysaccharide vaccine (PPV) program.
- To analyze costs from both healthcare and societal perspectives in Sierra Leone.
Main Methods:
- A dynamic transmission model was used to estimate costs and health outcomes.
- Calculations included direct healthcare costs, averted costs, and avoided productivity losses.
- Cost-effectiveness was measured per Disability-Adjusted Life Year (DALY) averted.
Main Results:
- The maternal PPV program cost $606 per DALY averted from a healthcare perspective and $132 from a societal perspective.
- The intervention was cost-effective from a societal perspective but not a healthcare perspective using Sierra Leone's GDP per capita ($527).
- Sensitivity analyses showed cost-effectiveness from a healthcare perspective was achievable without discounting health benefits or with lower vaccine procurement costs.
Conclusions:
- Maternal pneumococcal vaccines show potential for cost-effectiveness in low-income countries.
- Negotiating vaccine prices with providers is essential for low-income countries to self-finance this intervention.
- Vaccine price is the primary driver of cost-effectiveness for maternal pneumococcal vaccination programs.
Abstract:
Maternal pneumococcal vaccines have been proposed as a method of protecting infants in the first few months of life. In this paper, we use results from a dynamic transmission model to assess the cost-effectiveness of a maternal pneumococcal polysaccharide vaccine from both healthcare and societal perspectives. We estimate the costs of delivering a maternal pneumococcal polysaccharide vaccine, the healthcare costs averted, and productivity losses avoided through the prevention of severe pneumococcal outcomes such as pneumonia and meningitis. Our model estimates that a maternal pneumococcal program would cost $606 (2020 USD, 95% prediction interval 437 to 779) from a healthcare perspective and $132 (95% prediction interval -1 to 265) from a societal perspective per DALY averted for one year of vaccine delivery. Hence, a maternal pneumococcal vaccine would be cost-effective from a societal perspective but not cost-effective from a healthcare perspective using Sierra Leone's GDP per capita of $527 as a cost-effectiveness threshold. Sensitivity analysis demonstrates how the choice to discount ongoing health benefits determines whether the maternal pneumococcal vaccine was deemed cost-effective from a healthcare perspective. Without discounting, the cost per DALY averted would be $292 (55% of Sierra Leone's GDP per capita) from a healthcare perspective. Further, the cost per DALY averted would be $142 (27% GDP per capita) from a healthcare perspective if PPV could be procured at the same cost relative to PCV in Sierra Leone as on the PAHO reference price list. Overall, our paper demonstrates that maternal pneumococcal vaccines have the potential to be cost-effective in low-income settings; however, the likelihood of low-income countries self-financing this intervention will depend on negotiations with vaccine providers on vaccine price. Vaccine price is the largest program cost driving the cost-effectiveness of a future maternal pneumococcal vaccine.
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