Economic Evaluation of PHID-CV versus PCV10-SII Compared with no Vaccination in the Philippines

Area of Science:

• Public Health
• Health Economics
• Vaccinology

Background:

• Streptococcus pneumoniae causes invasive pneumococcal disease (IPD), including pneumonia, meningitis, and bacteremia.
• The Philippines utilizes PCV13 and PHiD-CV in its national immunization program.
• A new 10-valent pneumococcal conjugate vaccine (PCV10-SII) has received WHO prequalification.

Purpose of the Study:

• To assess the cost-effectiveness of two 10-valent pneumococcal conjugate vaccines (PCV10-SII and PHiD-CV) in the Philippines.
• To compare the cost-effectiveness of PCV10-SII and PHiD-CV against no vaccination.
• To evaluate the relative cost-effectiveness between PCV10-SII and PHiD-CV.

Main Methods:

• An adapted Markov model was used to evaluate health outcomes and costs in the Philippines.
• The model simulated outcomes like bacteremia, meningitis, pneumonia, acute otitis media (AOM), sequelae, and death over a 5-year horizon.
• Quality-adjusted life years (QALYs) and lifetime costs were calculated, with a 3.66% discount rate applied. PCV10-SII price was modeled at a 20% discount, with sensitivity analyses conducted for price reductions of 5-15%.

Main Results:

• Both PCV vaccination strategies dominated the 'no vaccination' strategy, offering greater health benefits at lower overall costs.
• PHiD-CV demonstrated a higher incremental cost-effectiveness ratio (ICER) of 54,553 Philippine pesos (PHPs) per QALY gained compared to PCV10-SII in the base case.
• PHiD-CV yielded more QALYs (ΔQALY: 2929) by preventing more cases of meningitis, bacteremia, and AOM, albeit at a higher direct cost due to vaccine price differences.

Conclusions:

• Both pneumococcal conjugate vaccine strategies are superior to no vaccination, providing enhanced health benefits at reduced total costs.
• While PHiD-CV resulted in more QALYs gained, it incurred higher direct costs compared to PCV10-SII.
• The cost-effectiveness findings are highly sensitive to the assumed price of PCV10-SII, with PHiD-CV becoming dominant if PCV10-SII price reduction is 5% or less.