Evaluating the implementation of the 20-valent pneumococcal conjugate vaccine for paediatric immunization in...

In Australia, the paediatric national immunization programme (NIP) currently includes 13-valent pneumococcal conjugate vaccine (PCV13) under 2 + 1 schedule. The 15-valent (PCV15) and 20-valent pneumococcal conjugate vaccines (PCV20) are available in Australia but not yet NIP funded. This cost-effectiveness analysis compared the public health and economic impact of implementing PCV20 into the Australian paediatric NIP versus PCV13 and PCV15.

We conducted the cost-effectiveness analysis from the payer perspective using a population-based multi-cohort model with a 10-year horizon and a 5 % annual discount rate for costs and benefits. The model considered direct vaccine effects in the vaccinated cohort aged <2 years and indirect effects in unvaccinated individuals of all ages. Input data for epidemiology, costs, and utilities were obtained from Australia-specific sources. Vaccine effectiveness inputs were derived from PCV13 real-world effectiveness data, 7-valent pneumococcal conjugate vaccine (PCV7) efficacy data, and PCV13 impact data. Model estimated pneumococcal disease cases (invasive pneumococcal disease, pneumonia, and otitis media), deaths, costs, and quality-adjusted life years (QALY) for each vaccination strategy, which were used to calculate incremental cost-effectiveness ratios. Sensitivity analyses were conducted to test uncertainty in input parameters and examine model robustness.

Model estimated that PCV20 implementation would prevent more disease cases and deaths than PCV13 (642,804 and 8308, respectively) and PCV15 (290,943 and 3730, respectively) over 10 years. PCV20 was associated with QALY gains of 117,417 and 55,279, and total cost-savings of AUD 668,174,379 and AUD 312,296,604 versus PCV13 and PCV15, respectively. Therefore, PCV20 was predicted to be the dominant vaccination strategy versus both comparators. PCV20 was also dominant versus PCV13 in 97.40 % of probabilistic sensitivity analysis iterations and versus PCV15 in 85.70 % of iterations.

This cost-effectiveness analysis estimated that adoption of PCV20 into the Australian paediatric NIP would be dominant versus PCV13 and PCV15, leading to health benefits and cost-savings.