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Comparison of 13-, 15- and 20-valent pneumococcal conjugate vaccines in the paediatric Canadian population: A
Alison E Simmons1,2, Gebremedhin B Gebretekle1, Robert Pless1
1Infectious Diseases and Vaccination Program Branch, Public Health Agency of Canada, Ottawa, ON.
Insights
New pneumococcal conjugate vaccines (Pneu-C-15 and Pneu-C-20) may be cost-effective for Canadian infants. They are projected to reduce pneumococcal disease burden compared to the current Pneu-C-13 vaccine.
Area of Science:
- Public Health
- Vaccinology
- Health Economics
Background:
- Two new pneumococcal conjugate vaccines, Pneu-C-15 and Pneu-C-20, covering 15 and 20 *Streptococcus pneumoniae* serotypes, are now approved for Canadian children.
- The existing vaccine in routine use is the 13-valent conjugate vaccine (Pneu-C-13).
Purpose of the Study:
- To evaluate the cost-effectiveness of initiating routine pneumococcal vaccination in infants with Pneu-C-15 and Pneu-C-20 compared to Pneu-C-13.
- To assess the economic value of newer vaccines from both health system and societal perspectives.
Main Methods:
- A static cohort model was employed to estimate incremental cost-effectiveness ratios (ICERs) in 2022 Canadian dollars per quality-adjusted life year (QALY).
- The model considered a 10-year program-level time horizon and a lifetime individual-level horizon, with a 1.5% annual discount rate.
- Scenario and sensitivity analyses were conducted to explore uncertainties in model parameters and assumptions.
Main Results:
- Pneu-C-20 and, to a lesser extent, Pneu-C-15 are projected to decrease the burden of pneumococcal disease compared to Pneu-C-13.
- Based on product costs, ICERs for Pneu-C-15 and Pneu-C-20 were $58,800 and $135,200 per QALY gained (health system perspective) and $18,272 and $93,416 per QALY gained (societal perspective).
- A 5% or greater reduction in serotype-attributable disease from indirect vaccine effects lowered ICERs below $30,000 per QALY gained for both new vaccines.
Conclusions:
- Both Pneu-C-15 and Pneu-C-20 are anticipated to enhance quality-adjusted life years (QALYs) in Canadian children relative to Pneu-C-13.
- These newer vaccines represent potentially cost-effective interventions for the Canadian pediatric population.
Background:
Two pneumococcal conjugate vaccines, covering 15 and 20 Streptococcus pneumoniae serotypes (Pneu-C-15 and Pneu-C-20, respectively), were recently approved for use in the Canadian paediatric population.
Objective:
To assess the cost-effectiveness of Pneu-C-15 and Pneu-C-20 in unvaccinated infants initiating routine pneumococcal vaccination, compared to the currently used 13-valent conjugate vaccine (Pneu-C-13).
Methods:
A static cohort model was used to estimate sequential incremental cost-effectiveness ratios (ICERs in 2022 Canadian dollars per quality-adjusted life year [QALY]) of Pneu-C-13, Pneu-C-15 and Pneu-C-20 in the paediatric population starting their primary series. Costs and outcomes were calculated over a 10-year time horizon at the program level and a lifetime time horizon at the individual level and discounted at a rate of 1.5% per year. We explored the impact of uncertainties in model parameters and assumptions in scenario and sensitivity analyses.
Results:
Routine use of Pneu-C-20 and, to a lesser extent, Pneu-C-15 is projected to reduce pneumococcal disease burden, compared to Pneu-C-13. Based on product cost assumptions, sequential ICERs for Pneu-C-15 and Pneu-C-20 were $58,800 and $135,200 per QALY gained from the health system perspective and $18,272 and $93,416 per QALY gained from the societal perspective, excluding indirect effects. A reduction in serotype-attributable disease due to indirect vaccine effects of 5% or greater resulted in ICERs below $30,000 per QALY gained for Pneu-C-15 and Pneu-C-20, with the optimal strategy determined by the magnitude and time to reach a reduction in pneumococcal disease.
Conclusion:
Both Pneu-C-15 and Pneu-C-20 are expected to increase QALYs in Canadian children compared to Pneu-C-13 and may be cost-effective interventions.
