Cost-Effectiveness Analysis of Routine Childhood Immunization with 20-Valent versus 15-Valent Pneumococcal Conjugate...

Area of Science:

• Health Economics
• Vaccinology
• Public Health

Background:

• Pneumococcal conjugate vaccines (PCVs) are crucial for preventing pneumococcal diseases.
• Germany currently uses a 13-valent PCV, with 15-valent (V114) and 20-valent (PCV20) vaccines offering broader serotype coverage.

Purpose of the Study:

• To evaluate the cost-effectiveness of routine childhood immunization with PCV20 (3+1 schedule) versus V114 (2+1 schedule) in Germany.
• To assess the economic impact from a societal perspective, including direct and indirect costs.

Main Methods:

• A decision-analytic Markov model was employed to simulate lifetime costs and outcomes for a German birth cohort.
• Vaccine effectiveness data from existing studies were used, incorporating indirect effects like herd protection and serotype replacement.
• Scenario and sensitivity analyses were conducted to test the robustness of the findings.

Main Results:

• PCV20 demonstrated higher effectiveness, preventing more pneumococcal disease cases and deaths, and yielding an additional 96 quality-adjusted life years (QALYs) compared to V114.
• However, PCV20 incurred a substantial incremental cost of over EUR 48 million, leading to an incremental cost-effectiveness ratio (ICER) of EUR 503,620/QALY.
• The majority of analyses indicated an ICER for PCV20 exceeding the commonly accepted threshold of EUR 150,000/QALY.

Conclusions:

• Routine childhood immunization with PCV20 in Germany is unlikely to be an economically efficient strategy compared to V114.
• The higher costs associated with PCV20 may outweigh its incremental health benefits within the German healthcare context.
• Further economic evaluations considering specific healthcare system dynamics and long-term outcomes are warranted.